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Ulcerative Colitis
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Posted 12/12/2018 11:50 PM (GMT 0)
Well, after a month of 'getting this, nope...getting that...nope...getting something else; saw my gastr doctor today. He's been a good doctor for me for over 20 years. He was visibly upset by my insurance's denial of Entyvio, Simponi, and Xeljanz and called them. After a few hours wait for a response from BlueCross/BlueShield, they gave prior approval for Humira. LOL Doc called my pharmacy and they were supposed to call him back to find out about delivery. They failed to call him of course. So, I called pharmacy and was told insurance approved it but said I'd have to use a different pharmacy!!! Sheesh Our pharmacy...Food Lion...a dang grocery store with a pharmacy!!! I have NO objections to using a different pharmacy...time to do so anyway; I just wish my dear insurance company would TELL ME which one they want me to use. First they dictate WHAT I can take, now they dictate WHERE I can get it. Pharmacist told me to ask my doctor. I did, but by that time, they were closed. So, just another couple of days wait. In the meantime, I've been put back on prednisone due to my current flare...which has become a bit worse. From what I've been able to read so far, Humira seems about as good as the other biologics. Time shall tell...HOPEFULLY!!! Stay well, in remission, or put on a good 'front'. Good luck all
Posted 12/13/2018 12:02 AM (GMT 0)
My pharmacy coverage had me get my Humira (and now Xeljanz) from Accredo. I haven’t actually heard of anyone getting Humira, at least, from a non-specialty pharmacy. They just overnight it when you need a refill. I’ve been told that they do this because it’s so gods-blessed expensive that they keep it on a pretty short leash—one month at a time, refills no earlier than 10 days out, and frequent reauthorization.

Good luck! I know it’s super irritating to be hung up by bureaucracy.
Posted 12/13/2018 1:35 AM (GMT 0)
Thanks Cele….I hope it works! LOL
Posted 12/13/2018 2:18 AM (GMT 0)
Back when I was on Humira, it came from a "specialty pharmacy" through my insurance. It was delivered in a cooler with cold packs. My gi's office contacted my insurance & they gave the lady all the info she needed. She had to fax the script to them. I am not sure why your gi's office didn't handle it right. Meds like Humira that are so expensive are not something we can walk into the pharmacy & pick up. I had no problem with the delivery & it always showed up on time. Call & speak to your gi's office in the morning.
Posted 12/13/2018 1:16 PM (GMT 0)
Thank you Stray... I certainly shall. It's 'funny', because in over the 20 years of UC, I'd never had any problems with my insurance or pharmacy. My doctor has a really great staff who have always come through. I'll call as soon as they open this morning. Stay well and good luck
Posted 12/13/2018 2:02 PM (GMT 0)
I haven't taken Humira for four years, but I have Blue Cross/Blue Shield insurance and my prescription came from CVS Caremark. They received the prescription from the GI doctor's office. I just called when I was ready for a shipment and they sent it right away with in a cooler with Ice Packs. There were no issues.
Posted 12/13/2018 3:28 PM (GMT 0)
Frustrating from both a patient (and also imagine) a doctor's perspective as well, when insurance calls all of the shots. I'd say arguing with insurance is the official past time of the chronically ill <_<. At times we gotta be the middle-man, making sure everyone else (doc and insurance) has provided/received the needed info and that there's no holdups (Like, look knuckleheads what's the holdup here...).

Generally, I've been able to use whatever pharmacy I want to. I might have to switch with the new year's policy though, so we'll see on that one.
Posted 12/13/2018 3:52 PM (GMT 0)
I am not fan of the way pharmaceuticals and insurance is set up in US. But lets blame them for what they are doing wrong, and not stray into blaming them for misunderstandings.

The injectable biologics almost always come form a specialty pharmacy. Thinking a FoodLion pharmacy could dispense it is just a misunderstanding.

Insurance dictates what they will cover. They do this within the contract established when the insurance product is purchased. It is not accurate to say "First they dictate WHAT I can take, now they dictate WHERE I can get it." because they only First they dictate WHAT is covered, and WHERE some items are distributed. We have a for-profit pay-for-service medical and medicine system in this country. We are free to have any doc we want, to get any legal treatment we want, and get it anywhere we want - as long as we pay for it. IF we want to use an insurance plan to manage our costs, we have to work within the contract of the plan - or buy insurance with a more favorable contract.
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