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Hi, my name is Scott Anderson, my son Corey age 28 suffers from Crohn’s disease for many years. He has fallen on hard times, had to give up employment because of Covid, lost health coverage ,now covered under Amerigroup, ( Medicaid) . His Gastroenterologist recommended Remicade for Corey, Amerigroup refuses to cover Remicade despite two appeals . Looking for immediate help for options, I really would appreciate any advice , thanking you in advance,Scott Anderson

my little penguin

Staff member

Contact Janssen
Has he tried other meds first ?
Some require the failure of other cheaper drugs first
And those have to be trialed for a set amount of time
My kiddo was dx at age 7 and now is 17
We have a parents group (and a lot of the “ kids “ are adults btw )
Ds had to trial Pentasa , 6-mp, and methotrexate-fail all of them before private insurance would approve remicade .
Will it approve humira ?
Some insurances like different biologics first .
Definitely read the clauses
Might be easier to get a different biologic first
Remicade is through medical insurance
Humira is through prescription plan so different sides of the insurance

Ds has been on remicade , humira and now Stelara over the past 9 years .
Thank you for reply, as Corey is on Medicaid, Janssen can not or would not help, Corey’s been on various Meds over the years, the insurance company wants him to try Avsola , relatively new biosimiliar prior to considering Remicade, his Dr will not authorize the use of Avsola, concerns about the short time in use, so we are in a predicament, second appeal turned down yesterday, need answers in a hurry, help! Please

my little penguin

Staff member
Ohhh avsola is the bio similar
Makes sense now
A lot a folks here are being switched off remicade to the biosimilar
With any drug for some it works well and for others it does not
Since he is on Medicaid your only option after 2nd appeal is peer to peer
But honestly most folks have to try the biosimilar and prove it does not work for them before any insurance will cover remicade

might try getting a second opinion from another Gi
For other drug options but Medicaid does not budge if there is a similar cheaper option which in this case there is .
Insurances cover what they cover
They have dictated what brands of drugs can and can not be used
This can and does change