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Having trouble getting insurance to cover Humira

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Ulcerative Colitis
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Posted 11/13/2016 11:56 PM (GMT 0)
I have been battling UC for 3 years now with lots of ups and downs. None of the medication seems to work for long. My physician and I have decided it is time to try Humira with 6mp my insurance is dragging their feet. Any advice on getting the ball rolling, discounts on meds, success stories would be great to hear! Getting very frustrated at this point. Thank you all and my thoughts are with you and yours hopefully heading into a healthy holiday season!
Posted 11/14/2016 4:53 AM (GMT 0)
I dont know about humira, but mercaptopurine 6-mp is about $15 dollars per month for me without insurance.
Posted 11/14/2016 11:10 AM (GMT 0)

Jessdx2013 said...
I have been battling UC for 3 years now with lots of ups and downs. None of the medication seems to work for long. My physician and I have decided it is time to try Humira with 6mp my insurance is dragging their feet. Any advice on getting the ball rolling, discounts on meds, success stories would be great to hear! Getting very frustrated at this point. Thank you all and my thoughts are with you and yours hopefully heading into a healthy holiday season!

My doctor had me document my symptoms for a month so that he could use it as documentation for the prior authorization. I used a smart phone app called GI monitor. You record all your BM's, rate urgency, stool looseness, blood, etc. and you can use the app to print out reports with graphs and logs.

He also gave the rx to a specialty pharmacy that has a good track record of getting insurance company authorizations (sorry, I don't recall the name, but they do a lot of biologics and cancer meds). They got it approved but then it had to be transfered to my regular mail order pharmacy since they were out of network.

I've been doing Humira for 8 weeks now and am in remission. Humira is the BEST MED EVER!

Good luck.

wink wink
Posted 11/14/2016 1:26 PM (GMT 0)
It can take several weeks to get approval. Your health insurer requires proof of medical need for a new medicine through a series of requests back and forth to to show that lesser medications have first been tried and failed etc, until insurance reluctantly agrees that you need the medication and it's approved.

It can help to follow up with your insurer and doctor's office and make sure everything is proceeding. You'll also need to get a Tuberculosis (TB) skin test (check for current tb) and chest xrays (check for past tb) before starting a biologic. Perhaps you can ask your gasteroenterologist about getting those scheduled.

In the mean time, you can signup for humira's copay assistance programs which is highly recommended as injectible, special-pharmacy medications like this are often a lot more expensive than other medications you've tried.
/m.humiracomplete.com/cost-and-copay
Posted 11/14/2016 2:18 PM (GMT 0)
Thank you all for your input. I did download the GI app easy to use and looks like it will be helpful. I have been on a biologic before and have all necessary tests done. REMICAID was my tx med a year ago, I was enjoying remission with minimal side effects. Then we were forced to switch insurance companies and the new one refused to pay. We were unable to continue and were hoping that since I was in remission my body would stay there with diet, 6mp, lialda. That is not working, I have progressed to the point I am calling off work and trying like heck to avoid the hospital. Looking forward to a day I can plan outings with out looking for an outhouse! Lol
Posted 11/14/2016 4:46 PM (GMT 0)
Many companies prefer Remicade over Humira. Maybe the new company will approve the Remicade.
Posted 11/14/2016 5:50 PM (GMT 0)
Your doctor will most likely need to push the issue with the insurance company. Since remicade worked so well for you maybe you can go back to that if you haven't built up antibodies to it.

My Asacol HD wasn't on my formulary, but my doctor's office pushed the issue with the insurance company and they approved it on appeal after initially denying it. You can be successful with appeals to insurance, but you need your doctor's office to do that pushing.

Good luck!
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