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A month to get Humira approved?

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Ulcerative Colitis
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Posted 7/23/2014 7:53 PM (GMT 0)
So I am in a bad way. Bleeding, diapoos, etc. basically a classic severe flare. Went to my GI doc two weeks ago and requested Rowasa (the flare was just starting) because I didn't want to move to Humira just yet (Remicade gave me issues and was discontinued earlier this year). Called the doc's answering machine today and let them know the Rowasa wasn't working as I am bleeding pretty darn bad and am in pain.

The nurse calls back a few hours later and tells me the doc wants to get me on Humira and it will take a month to get through the authorizations through my insurance company (Aetna). I was like "are you for real? They approved my Remicade in less than a week". She said that was easier because its given through the hospital infusion center and as a specialty drug it takes longer to process authorization. I told her to get a hospital bed ready for me in a few weeks because no way was I going to be able to just be on 5 ASAs for a month. I asked her what I was supposed to do in the meantime and she said she'd ask the doc.

A prednisone prescription would have been standard procedure as some sort of bridge I would think. What in the heck? Needless to say I am beyond pissed.

What's everyone else's experience with getting Humira approved? Is it fairly timely? Is this nurse just incompetent? I'm not sure what to do at this point.
Posted 7/23/2014 7:58 PM (GMT 0)
I'd call back and specifically request an rx for prednisone.
Posted 7/23/2014 8:13 PM (GMT 0)
I'm in Canada (wondering if maybe you're in the US where things work a little differently) but I had to also wait a month for Alberta Blue Cross to kick in but in the mean time, Humira gave me pens for free until ABC kicked in so you should be talking to Humira, my GI's booking clerk set me up with a Humira coordinator that set everything up for me including applying for ABC because my hubby's benefits were soon ending. It was excellent, the lady from Humira called me the very next day to help set everything up with me.
Posted 7/23/2014 9:02 PM (GMT 0)
I think it took about a month for me to get Humira approved. I was prescribed Simponi a month ago today. I actually got a call from the specialty pharmacy this morning to set up delivery. As we were hanging up, she realized that only my maintenance dose had prior auth and not my loading dose. I called my nurse and she has been fed up with all of this as well. She said she was on the phone for 4 hours with BC/BS getting the prior auth for the loading dose. I should supposedly have it tomorrow. So, yes, from my experience about a month is what it's taken me for two separate biologics. My doc did prescribe prednisone for the first time to hold me over until I start it.
Good luck.
Posted 7/23/2014 9:11 PM (GMT 0)
Thanks for the feedback, folks! Yes, pb4 I am indeed in the USA and things do work a bit differently here. I am going to call the GI back tomorrow and ask for prednisone just in case I continue to worsen and need it. Oh and I'm also going to ask for a cdiff test because I have had it before and the last thing you want to do is start a biologic when you have a cdiff infection. I'm amazed that it takes so long given how quickly Remicade came through, but I guess it is what it is.
Posted 7/23/2014 11:33 PM (GMT 0)
I got simponi approved pretty quickly through bcbs. Unfortunately you have to go through a mail order pharmacy which was brutal because no one working there knows what's going on, nor do they have any understanding if how badly we need this stuff. It's not like we are getting it for fun, we are in pain and constantly going to the toilet, deflating like a tire with a blow out on a highway... I ended up getting it within a couple weeks but it took a lot of work on the part of my dr's office and myself. I had to speak to supervisors, billing, pharmacists, force them to do an overnight shipment. It was like having a third job. Even with all that work, they managed to ship the wrong item and charge me 3x. I recommend you keep bugging them until you get what you need.

What's a diapoo btw? I agree with fruit girl, get some pred if you can tolerate it. I'd rather cement a toilet to my backside than take pred.
Posted 7/24/2014 12:01 AM (GMT 0)
Best of luck poopypantalones, maybe also find out from your GI's office if Humira will cover your med for you until your insurance picks it up in about a month...it's bizarre that they would for us in Canada but not in the US, the goal after all is to get on Humira as soon as possible which is why I find it so strange that Humira wouldn't cover it for you for a month. My GI told me just before he RX it to me that whether I chose Humira or Remicade, neither would deny a patient that needs it even if they can't or never could afford it.
Posted 7/24/2014 12:47 AM (GMT 0)
My GI's old office had someone specifically on staff to help with all the specialty drug prescriptions, she had to jump through flaming hoops to get me Humira from BCBS but it took 4 days.

It's been about 18 months so things may have changed but I think that I remember Humira's Patients assistance program offering to help facilitate the ordering (paper work and stuff) with insurance companies. It might be worth a call to Humira and maybe they can help you with your co-pay costs too.

Since Vedolizumab/Entyvio is an infusion do you think that you can get that approved quicker? The stats say that it is more affective than Humira for UC, so it could be a better option for you.
Posted 7/24/2014 1:30 AM (GMT 0)
Regarding copay, I have to pay 25.00 a month for my one month supply, I can get that 25 covered by my hubby's benefits though, ABC doesn't cover the copay here in Alberta, but I can live with that...

I don't even think Humira's really been helping with my disease much lately (other than the fistula which I'm grateful for) to be honest so there's a good chance my GI will up my dosage from once every 2 weeks to once a week to see if it actually helps my symptoms that I'm still having (urgency and frequency).
Posted 7/24/2014 1:51 AM (GMT 0)
Yeah, unfortunately that sounds about right, Poopypantalones. Aetna took a month to get me Cimzia (I have Crohn's) and they just took almost two months to get me Entyvio. Their favorite move is to claim the doctor didn't give them the right information and keep requesting the same thing over and over again.
Posted 7/27/2014 5:03 PM (GMT 0)
Been waiting for Humira for two weeks! While in a bad flare and on predisone. I should be having a nurse come out this week. If not, I'm going to bother my doctor because this is just ridiculous. It's because a nurse must come out to your house and show you how to use the device. It's an entire different set-up then remicaide I assume. Hang in there, and bug your doctor and his office, that always gets things moving for me.
Posted 7/28/2014 5:39 PM (GMT 0)
They're requiring a nurse to come to your house to show you how to hold a Humira pen against your leg and press a button? No wonder health care costs are so high.
Posted 7/28/2014 8:01 PM (GMT 0)

bania said...
They're requiring a nurse to come to your house to show you how to hold a Humira pen against your leg and press a button? No wonder health care costs are so high.

They did the same for me, and said I could have her come as often as I needed...there is a proper way to do it and a wrong way, you don't want to hit any arteries, you have to pinch the area you're injecting (tummy or thigh) while you're injecting as well so some training is very helpful. And for the first time you're getting an injection you never know if you're going to have a bad reaction or not, so I think having a nurse come help is in a patients best interest.
Posted 7/28/2014 8:44 PM (GMT 0)
When I was on humira, the PA at my GI's office taught me how to use the pens. They also gave me a starter kit that I did not have to pay for.
Posted 7/31/2014 6:46 AM (GMT 0)
I just had the nurse come out today. And it was so informational! Plus they give you all of these things to help manage your medicine. Such as a calendar, notebook, trash for the pens etc... I would but them everyday to get them to come out. That's what I did and they finally came right away!
Posted 7/31/2014 12:52 PM (GMT 0)
When my GI wanted to put me on Humira it took a week or so to hear from insurance and they denied it. He then sent in an appeal and after waiting another week or so, we decided I was too sick to wait anymore. Knowing that insurance is more likely to cover Remicade (which is DUMB because it is so much more expensive!!), we went ahead and just started that without even asking them for approval. They did cover the Remicade, apparently because it is an in office/hospital treatment and not a prescription. Eventually we heard back about the Humira appeal, and they denied it again, telling me that I would have to try Cimzia first, and if that failed I could try Humira. None of that ever happened for me though.

Had I done the Humira, I was told I would go to the office for my first injection, so that a nurse could teach me some stuff and show me exactly what to do. Good luck getting the meds you need asap!!
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