Please provide the PAC contact info for Taframidis
June 29
Getting a denial is frustrating, but there are real options to push back and get access to tafamidis. Here's what can be done:
With Kaiser (Appeal the Denial)
- Request a formal appeal of the denial in writing
- Ask the doctor to submit documentation proving tafamidis is medically necessary for ATTR-CM
- Kaiser must Show Full Answer
Getting a denial is frustrating, but there are real options to push back and get access to tafamidis. Here's what can be done:
With Kaiser (Appeal the Denial):
- Request a formal appeal of the denial in writing
- Ask the doctor to submit documentation proving tafamidis is medically necessary for ATTR-CM
- Kaiser must explain why it was denied and provide appeal deadlines
- The doctor can highlight that tafamidis is FDA-approved specifically for ATTR-CM (both hereditary and wild-type)
Through the Manufacturer:
- The company that makes tafamidis offers Patient Access Coordinators (PACs)
- PACs help navigate insurance coverage, specialty pharmacy access, and financial assistance programs
- Reaching out to a PAC directly can open doors to manufacturer assistance programs
- If uninsured or underinsured, the doctor can submit a start form to the drug company It's worth noting that diflunisal is an off-label option that requires close monitoring due to potential stomach and kidney effects. Given a confirmed ATTR-CM diagnosis with a Grade 2 PYP scan, there's a strong medical case for tafamidis as the FDA-approved standard of care — which strengthens any appeal.
Connecting with an amyloidosis specialist (outside of Kaiser if needed) to support the appeal can also make a big difference.
June 29
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