I've been fighting to get coverage of Praluent, a cholesterol control medication that doesn't trigger rhabdomyolysis episodes in CPT2 patients. Statins, by contrast, put me in the hospital.
Anthem Blue Cross (California) refuses this coverage, preferring (whether expressly or simply as a result of a poorly designed policy) to pay for another hospitalization (the last one cost more than a lifetime of Praluent would have cost).
Please add in the comments section your own experiences with insurance companies insisting that you do things that are contraindicated in CPT2 patients. Please include the name and state of the insurance company. Good experiences, bad experiences, and neutral experiences are all welcome in the comments.
It is open enrollment season, and the more data the better.