Anyone have to get a new PA every 3 months for Humira?

catahoulagrl

New Member

Joined : May 2015

Posts : 7

Posted 6/28/2018 9:52 PM (GMT 0)

I started taking Humira in February of this year and it has been working quite well thankfully. I am having to struggle with getting another PA approved. The insurance company won't tell me how often I need a new PA, and I'm having to be the go-between b/w the pharmacy, the doctor's office, and the insurance b/c no one will tell me what they're doing. I am supposed to dose again this Sunday and likely won't get a PA approved before then.

Has anyone here had to get PA after PA to keep taking Humira? Like every 3 months? Also, how can I get help to get the paperwork submitted? Is there a patient advocacy group or anyone that deals with this kind of stuff?

I am absolutely exhausted from working full-time and having UC that I can't deal with this anymore.

Help!

iPoop

Forum Moderator

Joined : Aug 2012

Posts : 16483

Posted 6/28/2018 11:12 PM (GMT 0)

What's a PA?

Spring

Veteran Member

Joined : Jan 2017

Posts : 547

Posted 6/29/2018 3:19 AM (GMT 0)

I think it is pre-approval or pre-authorization.

Tristan1974

Regular Member

Joined : May 2018

Posts : 97

Posted 6/29/2018 6:08 AM (GMT 0)

Catahoulagrl: Your physician should send in the PA marked "urgent" so that the process is expedited by the insurance company. Also, insist that all relevant clinical notes supporting your need for Humira to be submitted with the PA so that there are no delays. Ask your physician to call the insurance's medical director if the PA is delayed (2 days) or is denied. If denied, an appeal should be filed immediately countering any and all reasons stated in the denial.

In my experience, 95% of the headaches stem from sloppy paperwork by the doctor's office.

Don't be afraid to be persistent with your doctor. It's part of their job to be your advocate.

Good luck!

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