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Blue Cross Blue Shield moving the age limit of humira to 18 - HELP

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Posted 11/20/2013 2:49 PM (GMT 0)
has this happened to anyone, my dad just got a call from the case worker that handles all the insurence stuff at childrens hospital saying that blue cross blue shilde is going try to move the age limit of humira to 18 years old and they won't renew my humira script for 2014. my dad said there going to try and fight it, but how long could that take? i only have til the end of january and then i'm out. how can a insurence company do something like this when i'm alredy takeing humira. humira is like my last option almost, i don't now what i'm going to do.
Posted 11/20/2013 3:22 PM (GMT 0)
Rango, this sucks. I wonder why they would do that? It isn't like its a new medication for you. Are you in the US or Canada?

You have a few options and it sounds like your dad is taking care of this. Try not to stress too much. Humira does have financial aid when you don't have insurance. Between your dad (and probably your doctor) dealing with Blue Cross and having this option I am sure something can get worked out.
Posted 11/20/2013 3:40 PM (GMT 0)
i'm in the U.S. , and thank you for very much, i'll try not to stress out but it plain out stinks. i have no clue why they would do thisconfused, i now my medical bills have cost alot but im sure there are other people with worse conditions and their bills are just as much. this is all probably because of the Obama Care BULL****
Posted 11/20/2013 4:02 PM (GMT 0)
I know, I am fighting with the pharmacy/insurance company to deal with the initial dosage for Humira and I am very stressed about this. Seems between the two of them they can't figure out that the 1st month she will actually need 7 needles (4 on day 1, 2 on day 15, 1 on day 29). Thank goodness for the Humira Patient Care person or I think I would be a screaming loonatic at the pharmacy right now. I am glad I am the one dealing with this and not my daughter. I hope by the time she deals with this on her own everything is simple and dealt with. Be glad your parents are there to help. I have heard of some parents that barely get involved with this they can't handle it.
Posted 11/21/2013 12:17 AM (GMT 0)
What state are you in Rango? A variety of BCBS I looked at in different states all have a requirement that the patient be 18 or older. Usually an insurance company will have exceptions to policy. Like you have to try A, B, and C before we will approve D. Your dad will likely call your doctor and have his office contact the insurance company.
Posted 12/2/2013 2:45 AM (GMT 0)
Rango did this get sorted out? Hope it is no longer a stresser!
Posted 12/2/2013 4:22 PM (GMT 0)
Its still not fixed yet and where just waiting i guess till january to see what happens with blbs. I think the people at childrens hospital sent an appeal to try and get this all strightened out. I'm not really stressed over it but ive been though so many different treatments i just dont want to switch again because of a stupid insurence company. Thanks for the replies and hope your daughter feels better.
Posted 12/3/2013 4:45 AM (GMT 0)
Rango16,
you should be grandfathered into the new policy requirements, Just for arguments sake I'd take it to the press and CCF and a few other places. Are they going to Guarantee a suitable replacement and how will they take care you if you develop antibodies?

Don't mind me I 'm still peeved at Remicade and the memory damage I have from it.
Posted 12/3/2013 11:52 AM (GMT 0)
everythings up in the air right now. it could be possible to sue them if they deny me my meds after they let me on them cus its medicaly nessisary. do you think if i started a petition it might stop them from doing this?(just a wild suggestion)
Posted 12/3/2013 1:12 PM (GMT 0)
YES,YES,YES,

Put as much attention on them as possible. I would contact every major news network as possible. The insurance and drug companies hate all the attention.

Greg

Posted 12/3/2013 2:35 PM (GMT 0)
I agree with 'I need help'. I'll sign it!

There needs to be a patient advocacy group. This is stressful to deal with everything + insurance. Keep us posted!
Posted 12/4/2013 7:09 PM (GMT 0)
I've been on Humira for a couple of years. My insurance company (not BCBS) tried at the beginning of this year to push me to Cimzia. I've been on Remicade but not Cimzia. Humira seems to be working for me, and I don't think it is a good idea to switch meds if you have a treatment plan that is working. My doctor agrees and was able to successfully appeal to the insurance company. (I think most of this was handled by a nurse on her team, but the doctor obviously had to agree and sign some paperwork.)

If you can get your doctor to do this for you, I think you've got a chance at the insurance company continuing to pay for the treatment.

You should also check out the humira website (humira.com). They have a financial assistance program that might be able to help even if BCBS quits paying. You could also call the number on the Humira website and talk to a drug representative. If BCBS is changing this rule, then you are not the only one impacted. They probably already know about this BCBS issue and may have suggestions on how to best solve the problem.
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