HELP Initial 4 shots insurance won't pay

[SVTJay]

Hi everyone I'm new here and have crohns disease. I am supposed to receive my first 4 shots of humira soon, however my insurance will not cover it at all. I have starmark which is a branch of aetna, along with caremark rx. The shots will cost $7280. I applied for the assistance program through myhumira and they will pay for $2400 of it (I believe). After the first 4 shots my copay should be $5 every two weeks with this program. However I'm still left with ~$5,000 to pay for the 4 shots. My question is does anyone know of any other programs that will help pay for my initial 4 shots? Has anyone else been in this situation and were you able to reduce the cost of your initial treatment? Thank you guys in advance, this has been so stressful.

 

[nogutsnoglory]

I am so sorry you are facing this financial burden. I know some have gotten the full cost of the medication covered by the assistance programs. Is it possible to call back and appeal to them?

 

[SVTJay]

I will call my insurance company and appeal first thing tomorrow. However I'm assuming the worse and that they won't budge, so I'm trying to find alternative programs and advice in the meantime. It seems there isn't many options other than myhumira.

 

[DougUte]

Sounds like your insurance is passing it off due to the fact you have the assistance program.

 

[Miss Underestimated]

Have you told your doctor about the problem paying that amount? They get samples.

 

[Katie127]

I had to get mine through a specialty pharmacy rather than my regular local pharmacy. The specialty place got it though by getting it as my doctor giving it to me rather than as a perscription. Plus it took a couple extra phone calls from my doctors office getting special authorization and me calling my insurance company and the specialty pharmacy and the myhumira place a few times. I'm on my second dose as of yesterday and the pharmacy has already sent me my doses for october. It took a lot of work and frustration, but it seems to be working.

Keep working at it and asking for solutions from your insurance company and whatever help your doctor's office can provide. Good luck.

 

[jlm]

I don't know how it works in the states but can you shop around for a better price. That seems awfully high for 4 Humira pens. I pick up four shots monthly and my bill is about 3200. Luckily it's all covered.

 

[Patricia56]

Usually you let your doctor know the prescription has been denied and they appeal it to the insurance company. If it it still denied then you can appeal that denial to the insurance company yourself.

It may be that it was denied because you had to use a specialty pharmacy like Katie127. We had the same problem. They denied it simply because it was written as a regular prescription and we didn't know to submit it to the mail order specialty pharmacy.

Check with your doctor's staff and see if they can help you and call the insurance to ask about why it was denied and if you need to use a special pharmacy.