Remicade denied, Cimzia+Imuran failed...what now?

[chrisnsteph1022]

Just found out that insurance denied Remicade for me, because I haven't failed Humira yet. However, my GI won't prescribe Humira because I've been on Cimzia for a year (4 months of Cimzia+Imuran) and I'm still getting worse. He says Humira is too similar to Cimzia to work for me. He's going to call insurance and try to fight it, but he had already told me if Remicade failed, there's nothing more he can do for me. I'll have to go to an IBD Clinic that does clinical trials. I'm losing hope of ever getting into remission.

 

[ThanksP]

I wouldn't like a doc that rules it out automatically. My last GI doc said the same thing of Remicade so I switched docs. I'm now loving life in full remission thanks to Remi.

Regardless, I'm sure once he calls, your insurance company will cover the Remicade. All he needs to do is give more of an explanation as to why he is prescribing Remi. I'll keep my fingers crossed for you!

Did you decide to try the Entocort? If I remember correctly, you don't do Pred, right?

 

[chrisnsteph1022]

That's correct. I did fill the entocort, but haven't taken any yet. If I get remicade, I'd like to know when/if it works and not wonder if it's the entocort.

 

[ThanksP]

I totally understand that. I'm curious to know how you feel on Entocort vs Pred if you do take it. If it's better, I may ask for it next time instead of Prednisone as well.

 

[chrisnsteph1022]

I've taken it before. I had no side effects. My side effects on pred were severe.

 

[chrisnsteph1022]

My doctor appealed the decision and got it overturned! Remicade is approved!! I start on Friday.

 

[suschex]

WooooHooooo!!!! I just now saw the first of this thread where you were denied and am so glad your doc got it approved for you! I hope it does the trick!!! Just in case it isn't the one, I agree with ThanksP about at least giving the Humira a try even if it means a new doctor.

Good to know about Entecort...coming off the pred right now and it is just no fun at all!

Sending you lots of luck with the Remicade!!!

 

[tiloah]

My doctor appealed the decision and got it overturned! Remicade is approved!! I start on Friday.

I was gonna ask if you were trying to have their decision overturned. So happy they changed their minds. I hope it works wonders for you!

 

[chrisnsteph1022]

What sucks is that I was due for my Cimzia last Friday. We held off since I was supposed to get the Remicade that day. I still haven't done the shot. I thought it wasn't working, but it was obviously doing SOMEthing because the past 4 days have been HELL. 15-20 bathroom trips/day, getting up 3-4 times a night, pain, nausea, the works. And I've had to work through it. I just hope the Remi works QUICKLY.

 

[ThanksP]

My doctor appealed the decision and got it overturned! Remicade is approved!! I start on Friday.

:dance::dance: That's GREAT news! Hope you get your first infusion soon and that it works quickly!