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Humira approval advice?

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Ulcerative Colitis
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Posted 4/2/2009 3:43 PM (GMT 0)
I've been waiting now for more than three weeks to get Humira approved. I knew it might not be easy, since under our Rx insurance (Caremark) it is a "specialty pharmaceutical" that requires review and, of course, Hurmira is not approved yet for UC. I'm told that since I did not meet the Humira guidelines, it is going through a review process involving BCBS. I'm told there is nothing more I can do to expedite it, and I think the case manager is sincere in her efforts and we talk almost every day.

Any advice, or insight about how long I should let this drag on before I just do Remicade instead? For many reasons I would prefer Humira, not the least of which is that it is a less costly approach to treatment even if it costs ME more (I care about controlling health care costs in this country generally). 

Should I do a Remicade infusion to get the ball rolling, then switch to Humira? I know I can ask my doctor, but it's on my mind right now and I wonder if anyone knows. This flare has been particularly draining on me and I'm eager to do something aggressive this time.

Appreciate any advice!

 

Posted 4/2/2009 4:49 PM (GMT 0)
Gah, Peety, how frustrating this must be! I don't know what to tell you, really. Was the case manager able to give you any sort estimate as to when there would be a decision? It sounds like you are really getting exhausted, though, so if I were you, I'd probably think about doing a Remi infusion just to see if you start to feel better.
Posted 4/3/2009 4:17 PM (GMT 0)
Humira was denied, no suprise I guess. I wish they would get that approved for UC! I'm sure I make too much to qualify for any of the drug company's programs.

So I am going on Remicade, as soon as that gets OK'd. Oh well, doc says she finds it works a little better anyway.
And with this bad flare she told me to take 40 mg prednisone, for a day (?), then 30 for the time being. Here comes the fuzzy moon face...bummer.
Posted 4/3/2009 4:21 PM (GMT 0)
Crap, Peety, that sucks. I know you really wanted to do Humira so that you didn't have to deal with going to the infusion center. How soon do you anticipate being able to start on Remicade? I hope it's soon and that it's your "miracle" drug!
Posted 4/3/2009 8:21 PM (GMT 0)
My doctor says that Remicade has a much higher success rate than humaria anyway. It isn't working for me so I am going to try Humaria my doctor said he can get it for me "off label"? Im not sure what that means.
Posted 4/3/2009 11:45 PM (GMT 0)
I'm hearing from my GI that Humira might be approved for UC as early as this fall.

Hana, "off label" simply means the doctor is prescribing it for something it isn't officially approved for by the FDA. Like Humira for UC. Doctors can always prescribe this way, whether your insurance will cover it is a different issue. Peety's request was reviewed and denied. My health policy clearly says off-label drugs are not covered, so they wouldn't even review it. This was why I had to wait for Remicade even though I was horridly sick.

On the other hand, in some countries you can't get drugs like Humira or Remicade at all except for a short course. They simply aren't available for maintenance. I guess there's no perfect system.
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