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Humira - how did you get approved to take it?

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Ulcerative Colitis
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Posted 6/4/2008 8:18 PM (GMT 0)
since it's not FDA approved for UC yet.  Just curious, thanks!
Posted 6/5/2008 5:00 PM (GMT 0)
bump.
Posted 6/5/2008 5:03 PM (GMT 0)
I think, from what I understand, you have to take Remicade first and if that fails then most insurance companies will allow Humira as the next option. Kind of like when they make you take a generic first before allowing the name brand.
Posted 6/5/2008 5:34 PM (GMT 0)
you are correct, ediekristen! Once Remicade fails, your insurance will cover Humira for UC. Of course, your GI has to jump thru hoops, but hey, it's part of the job! They won't cover it w/out you trying Remicade though.

Posted 6/5/2008 6:18 PM (GMT 0)
thanks for the info!
Posted 6/5/2008 9:09 PM (GMT 0)
Actually, it depends on your insurance coverage. Many policies specifically exclude medications that are used off label from coverage. In those cases, it's usually impossible to get coverage. So read your policy or check with your benefits coordinator at work. My coverage is very good, but does have that exclusion in it, and I was never able to get approval for Remicade until it was approved by the FDA. Believe me, I tried everything including submitting a detailed five-year cost analysis showing that Remi would be cheaper over that period than surgery. No dice.
Posted 6/5/2008 9:17 PM (GMT 0)
Good point, Judy. I didn't think about that aspect. My new insurance is the same... The coverage is pretty great for everything, except they don't cover contraception of any kind, infertility treatments of any kind (although they pay an amazing amount for pregnancy/newborn costs...hmm) and nothing that's off-label/not approved. There was some other things that I thought was strange but didn't really apply to me so I don't remember. Insurance is such a huge pain though.
Posted 6/5/2008 9:21 PM (GMT 0)
I know, Edie, I got a little dramatic with them on the phone one day and said "I guess it's cheaper to let me die, eh?"

But I know they're just doing what their contract with my employer provides for. They really don't have a personal vendetta out for me. Sometimes it just feels that way....
Posted 6/5/2008 9:33 PM (GMT 0)
Are there Humira trials going on? I know that's how many got on remi before it was labeled for UC or Crohns.
Posted 6/5/2008 10:22 PM (GMT 0)
My doc is doing a Humira trial, as well as a Colal-Pred trial and he said for me to choose which one I want. The colal-pred is obviously much safer, and only lasts 4 weeks. But, at the end of 4 weeks, you're S.O.L. and the drug won't be out for a couple of years. With the Humira, it's a one-year trial, everything paid for, etc. But I'm terrified of the side-effects. Check out www.clinicaltrials.gov and see if you can find a trial close to you.
Posted 6/5/2008 10:56 PM (GMT 0)
see, my insurance (I have Harvard Pilgrim HMO) also will not cover the off-label/unapproved drugs, but my GI told me that if everything else fails the doctors can get the insurers to cover it. Of course, he was told this by the Humira rep, so it may not be true! But I think when I started Remicade it was not covered for UC, only Crohns, & we did get full coverage. I'm lucky in that way, my infusions don't cost a thing. And funny enough, while I was at the infusion room this past Tuesday at my hospital, the nurses were talking about billing. They bill Remicade as a chemo drug! I'd talkw ith your GI- chances are, he's dealt with this before. I know my own GI has one specific nurse who does all the Remicade billing/scheduling, etc.
Posted 6/6/2008 1:32 PM (GMT 0)
crikey! What a mess! I will check this out next week w/my benefits provider. It's scary to know I am one more drug away from surgery. B/c I can't live my life like this, I just can't.
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