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Humira Pre-Authorization

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Ulcerative Colitis
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Posted 8/3/2012 10:12 AM (GMT 0)
Hello everyone,
This is my first time posting on this forum. My mom was diagnosed with ulcerative colitis in 2008 and after that I found this forum and read so many people's story and learned so much about this disease. Anyway, about two weeks ago my mom was diagnosed with pancolitis. I later found that this meant the entire colon has been affected. My mother has taken various medications but I believe the one that has helped her the most was a drug named remicade. She was in remission for about a year but then all of a sudden had an allergic reaction to the drug. Her GI concluded that she was now unresponsive to remicade so her GI insisted she go on the humira pens. Her GI said that it should take no longer than a week for the Prior authorization to be approved and it's now been almost 2 weeks and no word from the health insurance company. My question is anyone who is now on humira, how long did it take to get the authorization to be approved? Her health insurance is Cigna btw and we currently live in Arizona

Thank You in advance :)
Posted 8/3/2012 11:03 AM (GMT 0)
Just went through the same thing in June. Had to call the GI's office a few time to get the ball rolling. Called the insurance myself to see if I would be approved. They said they were waiting for my MD to send whatever they needed. Hope this helps. Took 2 weeks. They sent it overnight by mail.
Posted 8/3/2012 6:28 PM (GMT 0)
Thanks for the reply :-) Hopefully we'll get a call sometime tomorrow
Posted 8/3/2012 6:39 PM (GMT 0)
I am also waiting for authorization for Humira. I've been waiting for a week and a half so far. My doctor's triage nurse said it could take 2 weeks. I think I will call them monday to see what the status is -- not sure how much longer I can stay like this and eat potato soup everyday.
Posted 8/6/2012 7:42 PM (GMT 0)
Your Mom's experience closely follows mine. Diagnosed with ulcerative colitis and was on Remicade for 18 months. The effectiveness gradually declined to the point where I was at max dosage and receiving my infusion at 4 week intervals. Over the final 4 months, I developed increasingly active allergic reaction symptoms until I ended up in the ER. My GI took me off of Remicade and submitted Humira to CIGNA for approval. They immediately declined. My GI submitted Cimzia and that was declined too. After 5 weeks of back and forth w/CIGNA, my GI had a conference call hearing with a CIGNA doctor and they ended up approving Humira.

I've been on Humira for about 6 weeks and I'm feeling better without the crazy remicade side effects. No more 3 hour visits for infusion, feeling tired and like crap the rest of the day, and no allergic reaction symptoms yet. We'll see how long this lasts.

Don't give up. Get your GI to request a hearing and be persistent. Humira is a whole lot less expensive than Remicade but the insurance company doesn't want to pay anything if they don't have to. CIGNA will give in but it's a shame that you have to fight for it.

I hope all goes well with your Mom.
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