Humira being denied after a year

[scrapper1264]

DS9 has been on Humira for a year now and is doing so well. Today we receive a call that it is being denied by the insurance company. Pharmacy said the plan was "restructured" and people younger than 15 are not eligible. We have started an appeal process today through the insurance company. Anyone else been denied for this reason?

 

[Farmwife]

Sorry to hear that but I'm not surprised! I just found out my insurance won't cover my chiropractic visits because HEAD ACHES are pre-existing conditions. I hope you get a good outcome.
:soledance:Farmwife

 

[LilyRose]

I am so sorry to hear that - I can only imagine your distress when your son is doing so well on a particular medication, and to them be told they are no longer going to cover it.

I'm not in the USA so I don't fully understand the insurance stuff - but I hope you can resolve it. Does your doctor have any thoughts?

Take care,
L.

 

[izzi'smom]

I would have faith in the appeal process...if it is rejected a second time, appeal again. THis worked the last time I had to do it. My fingers are crossed for you!!!

 

[DustyKat]

Oh scrapper, I'm so sorry to hear this. I hope you can get things sorted with the insurance company ASAP...Good Luck!

Dusty. xxx

 

[Sascot]

That is awful. I agree with the others - keep appealing! Maybe it's worth getting the doctor to write a letter saying how well he is doing on Humira and how difficult it is to find a med that works well. Good luck

 

[Tesscorm]

Good luck!!! Sorry you have this additional concern! :ymad: Hope it's resolved quickly.

 

[polly13]

I am so sorry this has happened, I dont live in the US so dont fully understand the whole insurance thing but it is disgraceful that they are saying they wont cover it.

 

[Kelly2]

I just researched this for you and found that there is an Abbott Patient Assistance Program you can apply to. I would contact them, and let them know the situation.

This is part of what I read:

myHUMIRA reimbursement counselors can offer assistance with unfavorable coverage decisions. We can contact your insurance plan to determine why HUMIRA is not covered, research options to obtain coverage, and help facilitate this process with your physician. In the event that coverage for HUMIRA is still unavailable, reimbursement counselors can search for alternate coverage options that may provide access to HUMIRA. In some situations, this could include referrals to the Abbott Patient Assistance Foundation's HUMIRA Patient Assistance Program or other independent assistance programs.

Kelly

Kelly

 

[scrapper1264]

Thanks everyone for your kind words. The nurse is on top of it and is submitting the paperwork needed for the appeal. Thankfully we have a month's supply of med so hopefully it will be resolved by then.