Humira stopped due to insurance

[Bird22girl]

I will soon start amjevita due to my insurance no longer covering humira anyone else try this??

 

[dreamintwilight]

I'm in the same boat as you. Insurance is forcing me to switch to Amjevita effective January 2025, no longer covering Humira. I've been on Humira since 2010, which has kept me in remission. My GI doesn't seem to be concerned about the switch (and therefore is not inclined to go through the hassle of appealing), so I suppose that's what I'm going to do in January when I run out of my last Humira pens.

How long have you been taking Humira? Are you currently in remission? I'm hoping stable health will makeit more likely that the transition will go smoothly. I take weekly doses too, so am hoping there won't be issues getting Amjevita weekly, since even with Humira they still consider weekly injections "off label" dosing.

Have you signed up for the patient assistance program through Amjevita yet? I need to reach out and find out if they offer reimbursement to cover my medicine, which is how we have been paying for Humira (our insurance doesn't count co-pay assistance toward deductible or OOP).

Wishing you best of luck as you go through the same thing. Keep us posted how things go for you too!

 

[Bird22girl]

I'm in the same boat as you. Insurance is forcing me to switch to Amjevita effective January 2025, no longer covering Humira. I've been on Humira since 2010, which has kept me in remission. My GI doesn't seem to be concerned about the switch (and therefore is not inclined to go through the hassle of appealing), so I suppose that's what I'm going to do in January when I run out of my last Humira pens.

How long have you been taking Humira? Are you currently in remission? I'm hoping stable health will makeit more likely that the transition will go smoothly. I take weekly doses too, so am hoping there won't be issues getting Amjevita weekly, since even with Humira they still consider weekly injections "off label" dosing.

Have you signed up for the patient assistance program through Amjevita yet? I need to reach out and find out if they offer reimbursement to cover my medicine, which is how we have been paying for Humira (our insurance doesn't count co-pay assistance toward deductible or OOP).

Wishing you best of luck as you go through the same thing. Keep us posted how things go for you too!

Omg thanks for responding!!
I haven’t spoken to anyone for patient assistance yet. My GI doesn’t seem concerned either!! I’ve been on humira since 2022 and I finally feel OK so I don’t want to rock the boat LOL.
Let’s stay in touch and see how we both are doing if you don’t mind!?

 

[dreamintwilight]

Omg thanks for responding!!
I haven’t spoken to anyone for patient assistance yet. My GI doesn’t seem concerned either!! I’ve been on humira since 2022 and I finally feel OK so I don’t want to rock the boat LOL.
Let’s stay in touch and see how we both are doing if you don’t mind!?

Yes, let's definitely stay in touch/updated! Feel free to private message me if I miss a response on this thread, but I'm guessing our experiences might be helpful/relevant to others who may be in a similar boat. I 100% understand about not wanting to rock the boat with any changes. I'm hoping it'll be smooth sailing for both of us!

I did actually call the Amgen Support Plus program (for Amjevita) this week to get information on patient assistance and whether they had a reimbursement program similar to Humira. Good news is they offer both reimbursement as well as co-pay assistance to help with financial support! I still had to enroll in the Support Plus program (which is the co-pay card assistance program) so they could have a patient record for me, but then they sent me a link to sign up for their 3rd party reimbursement website. I realize not everyone is able to pay up front for medication and do reimbursement, but am grateful we have this option, which helps us meet our out-of-pocket max within the first few months of the year! I have other medical issues that require annual tests that are quite costly, so meeting our OOP max so early in the year really helps us financially!

I have one more refill of Humira left that I should be able to fill at the end of this month (if all goes as planned), so I actually might not end up needing Amjevita until February or March once I finish off my Humira supply. This will give me an extra buffer to sort out any delays that might happen with the switch over too (like prior authorization, prescription issues, etc).

 

[Anna's Bandit]

I was on Humira for 3 years. Got it for free from a patient assistance program. Have been on Stelara for 3 years and get that for free through a patient assistance program too. I am retired/disabled and collect SSD. I am low income. I do have health insurance through United health Care. Don't give up up, keep looking for resources !

 

[Bird22girl]

Yes, let's definitely stay in touch/updated! Feel free to private message me if I miss a response on this thread, but I'm guessing our experiences might be helpful/relevant to others who may be in a similar boat. I 100% understand about not wanting to rock the boat with any changes. I'm hoping it'll be smooth sailing for both of us!

I did actually call the Amgen Support Plus program (for Amjevita) this week to get information on patient assistance and whether they had a reimbursement program similar to Humira. Good news is they offer both reimbursement as well as co-pay assistance to help with financial support! I still had to enroll in the Support Plus program (which is the co-pay card assistance program) so they could have a patient record for me, but then they sent me a link to sign up for their 3rd party reimbursement website. I realize not everyone is able to pay up front for medication and do reimbursement, but am grateful we have this option, which helps us meet our out-of-pocket max within the first few months of the year! I have other medical issues that require annual tests that are quite costly, so meeting our OOP max so early in the year really helps us financially!

I have one more refill of Humira left that I should be able to fill at the end of this month (if all goes as planned), so I actually might not end up needing Amjevita until February or March once I finish off my Humira supply. This will give me an extra buffer to sort out any delays that might happen with the switch over too (like prior authorization, prescription issues, etc).

Same I got a 3 month supply before the year end!!! Keep me posted!!

 

[Bird22girl]

Yes, let's definitely stay in touch/updated! Feel free to private message me if I miss a response on this thread, but I'm guessing our experiences might be helpful/relevant to others who may be in a similar boat. I 100% understand about not wanting to rock the boat with any changes. I'm hoping it'll be smooth sailing for both of us!

I did actually call the Amgen Support Plus program (for Amjevita) this week to get information on patient assistance and whether they had a reimbursement program similar to Humira. Good news is they offer both reimbursement as well as co-pay assistance to help with financial support! I still had to enroll in the Support Plus program (which is the co-pay card assistance program) so they could have a patient record for me, but then they sent me a link to sign up for their 3rd party reimbursement website. I realize not everyone is able to pay up front for medication and do reimbursement, but am grateful we have this option, which helps us meet our out-of-pocket max within the first few months of the year! I have other medical issues that require annual tests that are quite costly, so meeting our OOP max so early in the year really helps us financially!

I have one more refill of Humira left that I should be able to fill at the end of this month (if all goes as planned), so I actually might not end up needing Amjevita until February or March once I finish off my Humira supply. This will give me an extra buffer to sort out any delays that might happen with the switch over too (like prior authorization, prescription issues, etc).

I'm in the same boat as you. Insurance is forcing me to switch to Amjevita effective January 2025, no longer covering Humira. I've been on Humira since 2010, which has kept me in remission. My GI doesn't seem to be concerned about the switch (and therefore is not inclined to go through the hassle of appealing), so I suppose that's what I'm going to do in January when I run out of my last Humira pens.

How long have you been taking Humira? Are you currently in remission? I'm hoping stable health will makeit more likely that the transition will go smoothly. I take weekly doses too, so am hoping there won't be issues getting Amjevita weekly, since even with Humira they still consider weekly injections "off label" dosing.

Have you signed up for the patient assistance program through Amjevita yet? I need to reach out and find out if they offer reimbursement to cover my medicine, which is how we have been paying for Humira (our insurance doesn't count co-pay assistance toward deductible or OOP).

Wishing you best of luck as you go through the same thing. Keep us posted how things go for you too!

I’ve been taking Humira since 2022 and feel ok so I’m nervous but hopefully we will all be OK!!! keep me posted!!! I have Humira still till March so I’ll let you know how I’m doing when I start it..
Thanks so much!!!!

 

[dreamintwilight]

Hey @Bird22girl! Just checking in after I filled Amjevita for the first time this year. I still have plenty of Humira before I switch, but wanted to start filling Amjevita as soon as I could to make sure I maintained my stockpile of meds and also to get reimbursement going to help apply toward our insurance deductible (as I mentioned in my last post).

One issue I've come across is that the Amgen reimbursement/copay assistance maximum is $3,000 for the year. That means, whether you pay through reimbursement OR decide to use the co-pay card, they only allow $3,000 for the year. For me, that means after filling Amjevita only once for 2025, I've used up more than half of the reimbursement benefit and will end up using the rest of the funds at the end of the month when I refill again (due to weekly injections) and pay the rest out-of-pocket. I won't have anymore support funds to use for the rest of the year and will have to pay coinsurance for the rest of the year (unless I hit my out-of-pocket maximum).

When I asked the Amgen support rep what patients are supposed to do if they run out of funds - if there were other options available for assistance - she said I would have to call back once the funds run out for her to be able to discuss other options with me. It just seems wrong that they put patients through undue stress who want to try and plan ahead financially (and make sure they can continue take their medication) and they won't share that information until you're already in a difficult situation.

 

[dreamintwilight]

I was on Humira for 3 years. Got it for free from a patient assistance program. Have been on Stelara for 3 years and get that for free through a patient assistance program too. I am retired/disabled and collect SSD. I am low income. I do have health insurance through United health Care. Don't give up up, keep looking for resources !

Glad you are on something that works for you! I've been on Humira for over a decade and their patient assistance program has been great. My experience switching to a biosimilar (not by choice!) has not been an easy transition, thus far, so wanted to share the experience for others who may be in the same boat soon as it seems more insurance companies are deciding to cover biosimilars over the parent medications.

I've heard Stelara biosimilars may be the next one down the line (my mom is also retired and taking Stelara for free w/ a patient assistance program), so I'm hoping these biosimilar patient assistance programs improve because it seems clear that the "affordability" side of biosimilars is actually more geared toward the insurance company rather than the patient.