Insurance Not Paying for Humira

[Michelle89]

Just found out that my insurance denied payment for my Humira prescription. Has this happened to anyone else? Did you go with a different drug or did you find assistance? I was given info for the Abbvie Patient Assistance Program and wondering if anyone is using this program?

 

[Manzyb]

Hi Michelle,

I have heard of people doing the asisstence program, but I don't know anything about it to help you out!

When my doc switched me from the regular Humira dose, to taking one shot every week, insurance denied that. However, my doctor wrote an appeal letter to the insurance company saying that I really needed this drug. I would maybe ask your doc to do that? It worked for me, I don't know if it always works though.

Good luck to you!

 

[Michelle89]

Manzyb: Is that your little girl? She is adorable!

And thanks, I'm calling the my GI in the morning. I'll see if they can do anything.

 

[Dukeis]

Just found out that my insurance denied payment for my Humira prescription. Has this happened to anyone else? Did you go with a different drug or did you find assistance? I was given info for the Abbvie Patient Assistance Program and wondering if anyone is using this program?

Would your insurance company happen to be United Health Care? Some people use the Humira assistance program and it really helps. I don't know if it pays the full cost of the Humira, but it is sure worth looking into. I heard of some people only having to pay $5 a month to get their Humira.

 

[Michelle89]

Dukeis: It is called Cofinity but I think it is a part somehow of United Health Care.

I have contacted the Humira assistance program and it is in the works. Apparently there is some confusion somewhere. My GI nurse said yesterday she talked someone who said I do have approval, the people at Humira who checked out my insurance are still saying there is no approval. Either way I started the patient assistance process as we have a 3500.00 deductible which they said it's possible they may be able to help. $5 co-op wow, I don't think we've ever had that! lol

My concern is if they totally deny me coverage of taking humira and I develop a rare side effect needing treatment - would they cover the expense of that or say we didn't want you taking the drug and we won't pay for any side effect problems. Not that anyone can answer that for me just a concern..... I guess we will wait and see first if they are or aren't covering...

Thanks!

 

[Dukeis]

I had United Health Care of the River Valley I believe it was called and they wouldn't pay for Humira. They would pay for Cimzia. My doctor sent a letter explaining why he never wanted me switched to Cimzia and they still would not do it. Luckily my wife switched jobs about that time and her new insurance pays for Humira.

Hopefully you can get it all figured out and it works out for you.

 

[Michelle89]

Just got off the phone with Pharmacy Solutions who has been helping me with both my insurance and the Humira patient assistance program. The latest on trying to get insurance approval with a third supposed insurance approved pharmacy is that it is covered.......but they won't pay any of the cost of the medicine.......What the **** does that mean!!!!!!!!!!! :ybatty: Very frustrated!

I have started the Abbvie patient assistant application process with humira but wondering if I would have any better luck with getting approval - meaning they actually pay for the medicine! - for Remicade. Just want to get started on something at this point. I feel like I'm back at square one with 2 months wasted.

Being on prednisone is not helping me deal well with this right now!:yfrown:

Okay, vent done .......for now. This may need to me moved to the venting forum, lol.

 

[Dukeis]

Just got off the phone with Pharmacy Solutions who has been helping me with both my insurance and the Humira patient assistance program. The latest on trying to get insurance approval with a third supposed insurance approved pharmacy is that it is covered.......but they won't pay any of the cost of the medicine.......What the **** does that mean!!!!!!!!!!! :ybatty: Very frustrated!

I have started the Abbvie patient assistant application process with humira but wondering if I would have any better luck with getting approval - meaning they actually pay for the medicine! - for Remicade. Just want to get started on something at this point. I feel like I'm back at square one with 2 months wasted.

Being on prednisone is not helping me deal well with this right now!:yfrown:

Okay, vent done .......for now. This may need to me moved to the venting forum, lol.

Wow! Those insurance companies are something else. Have you ever been on Remicade? If not and your insurance will pay for it you may want to give it a try. I was one Remicade for 7 years and it worked great. I think it worked better for me then Humira.

 

[nogutsnoglory]

I would look to the book by Jennifer Jaff which has appeal letters. Try to contest this and don't accept their denial.

http://advocacyforpatients.org/know_your_rights.html

 

[Michelle89]

Wow! Those insurance companies are something else. Have you ever been on Remicade? If not and your insurance will pay for it you may want to give it a try. I was one Remicade for 7 years and it worked great. I think it worked better for me then Humira.

I have not been on Remicade before. Glad it worked for you for so long! Good to know.

 

[Michelle89]

I think everything is now worked out with insurance. Just took someone who knew how to communicate and actually do their job. :ybatty:

Unfortunately, now my schedule is getting super busy and I'm nervous how I'm going to get everybody where they need to be and deal with the loading dose. Seems like everyone says the loading dose wipes them out for a few days. I wish this could have been taken care of earlier when I had a more free schedule....but I am thankful it's been worked out.

 

[Scaryman]

Dukeis: It is called Cofinity but I think it is a part somehow of United Health Care.

I have contacted the Humira assistance program and it is in the works. Apparently there is some confusion somewhere. My GI nurse said yesterday she talked someone who said I do have approval, the people at Humira who checked out my insurance are still saying there is no approval. Either way I started the patient assistance process as we have a 3500.00 deductible which they said it's possible they may be able to help. $5 co-op wow, I don't think we've ever had that! lol

My concern is if they totally deny me coverage of taking humira and I develop a rare side effect needing treatment - would they cover the expense of that or say we didn't want you taking the drug and we won't pay for any side effect problems. Not that anyone can answer that for me just a concern..... I guess we will wait and see first if they are or aren't covering...

Thanks!

Honestly Abbot has been wonderful in my case. I had no insurance, now I have insurance with no pre existing. So me going from a decent salary to poverty in a year has had a effect on me. Without Abbott's assistance I'd never be on Humira. Between your Dr and Abbott and this forum's support I'm confident there will be a solution. I hope this helps.

 

[Thermo]

Eh just start the loading doses and move on, your body is different than everyone else's, its never a good time to inject. While you are on it you will have to inject at times when you don't feel like it or want to so its better to start getting in the habit now. I remember I got a huge head rush and I felt really odd for the rest of the day but then it was business as usual. If it works for you you will actually come to love injection day because you almost instantly feel better.

 

[Michelle89]

Decided to get it done as soon as possible. The meds were delivered Tuesday and was in on Wednesday to do the initial loading dose. Did pretty good Felt sorta flu like last night but that's it. I feel great today! I would do it again for even a few days of feeling like I do today. I hope this is a good sign of what's to come.

 

[Dukeis]

Decided to get it done as soon as possible. The meds were delivered Tuesday and was in on Wednesday to do the initial loading dose. Did pretty good Felt sorta flu like last night but that's it. I feel great today! I would do it again for even a few days of feeling like I do today. I hope this is a good sign of what's to come.

That is great! Hope it continues to help you feel better!

 

[tots]

Call Humira, by were awesome to deal with.


Lauren

 

[Miss Underestimated]

Fantastic!! I'm so glad you got this resolved, and got your Humira. It's helping me. I just pop that little clicky pen and get it over with, without thinking about it. Beats having Crohn's symptoms!

 

[Michelle89]

Fantastic!! I'm so glad you got this resolved, and got your Humira. It's helping me. I just pop that little clicky pen and get it over with, without thinking about it. Beats having Crohn's symptoms!

I am so glad it is working for you. It is reassuring to hear. I hope I will feel it soon! I don't think I'm going to feel much better until I'm off this Prednisone...grrrrrr. After the loading dose I had a partial day where I was shocked to get a taste of what life could be like with out ANY symptoms and was shocked at what I have gotten used to living with as a norm.

I have my second loading dose on Wednesday. I was so afraid to have shots but after having 4 shots in one setting, 2 (and eventually only 1) sounds like a breeze! And definitely worth feeling like I did that day I had without symptoms - hopefully years and years of it!

 

[tots]

I got all my loading doses delivered to my door for the $5 co-pay. Without it I couldn't use these meds!

I start next week, I sure hope it works!


Lauren