Ins denied xeljanz.

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psbg
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Date Joined May 2012
Total Posts : 280
   Posted 10/18/2016 6:52 PM (GMT -6)   
I have failed both enbrel and humira which is what the ins said I have to do in order to be considered for xeljanz. Now they are still denying it. Is this medication more expensive than the others??? I don't get it. I have failed a host of other meds as well. Orencia rituxan cimzia and a couple of others I can't think of right now. Anyone else have this problem with their ins. I am on private ins bcbs. Also if you have been on this medicine before can you tell me if it worked for you and the pros and cons taking it.
Hugs peggy

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 10/18/2016 7:38 PM (GMT -6)   
Have you done Leflunomide?
Joy
Lupus, RA, Fibromyalgia, Glaucoma, Asthma, Hypothyriodism, Sleep Apnea, Depression, Allergies, diabetes, and benign familia tremors

When life throws you lemons....
Pick them up and throw them right back at them! :))

psbg
Regular Member


Date Joined May 2012
Total Posts : 280
   Posted 10/18/2016 8:56 PM (GMT -6)   
What is the brand name for that. I don't recognize that name.
Peggy
Rhuematoid Arthritis, degenerative joints, herniated disc's in back and neck. Changed from Cimzia to Orencia injections now off Orencia started Rituxan infusion as of May 2014, Plaquenil 400 mg daily, 20 mg. prednisone, hydrocodone for pain. And like most of you I fight with fatigue regularly...

psbg
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Date Joined May 2012
Total Posts : 280
   Posted 10/18/2016 8:58 PM (GMT -6)   
Joy I'm sorry I just looked that up yes I believe I have tried that and failed it as well. I haven't tried actrimita? I m sure I spelled that wrong but my dr did mention that one.
Rhuematoid Arthritis, degenerative joints, herniated disc's in back and neck. Changed from Cimzia to Orencia injections now off Orencia started Rituxan infusion as of May 2014, Plaquenil 400 mg daily, 20 mg. prednisone, hydrocodone for pain. And like most of you I fight with fatigue regularly...

CA-Lynn
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Date Joined Jul 2016
Total Posts : 24
   Posted 10/19/2016 3:38 PM (GMT -6)   
On what grounds did they deny it? Can you appeal?

psbg
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Date Joined May 2012
Total Posts : 280
   Posted 10/19/2016 4:13 PM (GMT -6)   
Yes dr said they will appeal. Said not enough reason to support changing even though my doctors sent proof of where I failed the other meds. We are sending in appeal now. Last time I failed and dr tried to put me on xeljanz ins wouldn't approve so I had to try one of the same meds I had failed before. Not looking for the. To give it to me this time. Insurance companies stink these days but I know it has a lot to do with the big drug companies and the way the insurance laws are today. Too bad for me and folks like me.
Hugs peggy
Rhuematoid Arthritis, degenerative joints, herniated disc's in back and neck. Changed from Cimzia to Orencia injections now off Orencia started Rituxan infusion as of May 2014, Plaquenil 400 mg daily, 20 mg. prednisone, hydrocodone for pain. And like most of you I fight with fatigue regularly...

Don_D
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Date Joined May 2013
Total Posts : 548
   Posted Yesterday 11:41 AM (GMT -6)   
sorry to hear this psbg. I know depending on the ins co some meds are really discouraged because the costs are so high. I sat and figured out once how much money my meds had cost over the life of my disease and it was over 500k. I was and am still amazed.

I took xeljanz for a very brief period and I noticed an immediate improvement. Unfortunately I also developed an extreme side effect while on it and was not able to continue taking it. It affected my stomach in a severe way and the pain and swelling I experienced on it were more than enough for me to stop. I also have barrets syndrome as well as upper GI problems due to all the NSAID's over the years though so hopefully you can give it a try and it will work for you. I was pretty excited about it until the side effects kicked in. :(

Hope they get things ironed out with the insurance co and you have a chance to try it. -Don

msOuchie
Regular Member


Date Joined Dec 2011
Total Posts : 453
   Posted Today 3:19 AM (GMT -6)   
Hi Peggy:

I'm sorry that your Insurance is being so rude. Hopefully the appeal will be in your favour.
There is no reason why they should not cover it.

I started on Xeljanz in April. I started feeling better after about 2 months. It was so gradual that my Hubby noticed first since I was still in pain. Then I had about 4 months of feeling better - about 70% improvement which was great.

The first side effect I had was a mild throbbing on one side of my head. That disappeared in a short time. I was getting mild cramping and twitching in my legs during some nights. That only disappeared after I got off the Xeljanz. I was also getting bad back cramping on both sides of my spine in my lower back whenever I bent over to clean something, etc.

The end of September, my Hubby noticed that I had a fever. All that night I experienced being very warm and then freezing periods. I was in severe pain no matter what I did. My Hubby called 911 and I spent a week in the hospital with Pneumonia. Many tests, Doctors, i.v antibiotics, was taken off Xeljanz, more Morphine, higher dose Prednisone, inflammation was 150, Cortizone shot in my painful, swollen left knee, other fun stuff. They did get my inflammation down to 100 before I left the hospital , so I presume it has lowered even more. I have my next Rheumy appointment end of November. I had just seen my Rheumy 3 weeks prior to the ER excursion and I was doing well.

I'm feeling better now but I have failed most meds like you have. I look forward to the one that will work longer and maybe put me into remission. But I won't know unless I continue trying them. Good luck to you and us all. :)
Type 1 Diabetes - Severe Rheumatoid Arthritis(RA) - Asthma - Hypounawareness - secondary Raynauds - Osteoarthritis - Dry Eye - other stuff

Coversyl - Pantoloc(as irritation preventative) - Levemir - Indomethacin - long acting Morphine - short acting Morphine - Salbutamol - Prednisone - Humalog - Tears Naturelle II - Aspirin(81 mgs.) - Cod Liver Oil Caps - Vit D other OTC

psbg
Regular Member


Date Joined May 2012
Total Posts : 280
   Posted 11/10/2016 2:56 PM (GMT -6)   
Msouchie and don thanks so much for the information on how th xeljanz went for y'all. Sounds about the same for me as it was for don. I immediately noticed a difference. My doctor continues to give me samples of 30 pills so I'm ok right now. Hopefully soon I will get approved for them meds. Yes I looked at how much these meds cost and here where I am it was like 3400.00 a month. How crazy is that. They all have been high tho. The highest was the rituxan infusion I had to take. Anyway msouchie I'm so sorry you both had to quit taking it but I know that is what had to be done. Thankfully you are off the medicine. Usually mine just quits working on me. So far thank goodness I have not had any side effects on any. But I am wondering if this medicine is causing me to stay hungry. I have gained weight while I have been on it due to this problem. Any thoughts on that?
Thanks for talking with me. Hugs peggy

Don_D
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Date Joined May 2013
Total Posts : 548
   Posted 11/11/2016 7:32 PM (GMT -6)   
I tried another daily pill one this last week called Avara and the exact same problems came up. Massive swelling of my gut. I lasted 3 days before it kept me up all night in pain.

Im glad to hear that it has been helping you. I have never heard anything about weight gain with it but I know that I was holding a lot of fluids on both of them. Gained a few lbs both times and dropped them right off after stopping them.

msOuchie
Regular Member


Date Joined Dec 2011
Total Posts : 453
   Posted 11/12/2016 5:32 AM (GMT -6)   
Hi Peggy:

That's amazing with some patients these drugs work quicker than with others. Well, that's good to hear anyways. I hope that it continues for you. Wonderful that your Dr. can help you out with the med. My Rheumy did also until our Insurance covered mine. Didn't take long. Yes you're right, that price is crazy.

Are you on Prednisone? That can cause hunger and weight gain. Some people on the net say they gain liquid weight from RA. I don't know about that. Uncontrolled RA usually causes weight-loss.

This lady mentions about weight-gain while on Xeljanz, in her blog, if you are interested.
Different strokes for different folks. https://rudeawakenings.org/2013/09/11/ups-and-downs/

Ya, I was disappointed that I got Pneumonia but it does warn about respiratory infections with Xeljanz. Make sure that you keep aware of any symptoms of infections. Doesn't sound like there any other new RA medications on the near horizon.

Keep striving and stay well Peggy. :)
Type 1 Diabetes - Severe Rheumatoid Arthritis(RA) - Asthma - Hypounawareness - secondary Raynauds - Osteoarthritis - Dry Eye - other stuff

Coversyl - Pantoloc(as irritation preventative) - Levemir - Indomethacin - long acting Morphine - short acting Morphine - Salbutamol - Prednisone - Humalog - Tears Naturelle II - Aspirin(81 mgs.) - Cod Liver Oil Caps - Vit D other OTC

psbg
Regular Member


Date Joined May 2012
Total Posts : 280
   Posted 12/3/2016 5:52 PM (GMT -6)   
Msouchie you say you had pain in your head I have had pain on the right side of my head around the eye area back towards the temple. I thought it may be sinus related but not so sure now. Also I have began to have pain in my upper abdomen right under the breast bone. It is so painful I cannot hardly stand it.... I have to get up and walk move cannot sit. It will last for about five to seven minutes.... pain will build then all of a sudden it will go away. that has started today... I am wondering if that is from the xeljanz? I do not have a gallbladder but I have had a very small amount of diverticulitus many many years ago. Any thoughts on this? If that pain lasted any longer than that I honestly don't think I could stand it. It almost throws me into an anxiety attack it hurts so bad. Sounds crazy I know.
Hugs and I hope you are better
Peggy

msOuchie
Regular Member


Date Joined Dec 2011
Total Posts : 453
   Posted 12/4/2016 3:05 PM (GMT -6)   
Hi Peggy:

Gee whiz, that abdominal pain sounds dreadful. Especially for the length of time that you are experiencing it.
I had the same sounding pain in the middle of my abdomen, as you said, just below the breastbone. It was a bit concerning for me since it was painful and I hadn't experienced it there before. I didn't mention it, since it only lasted for about 30 seconds for me each time. I'd get up and walk around and it would disappear. If it had lasted as long as yours, I would have called up my Rheumy and asked for his advice and or even my Pharmacist and Xeljanz Nurse. That's what they are there for(among many other things). And NO, it doesn't sound crazy.

" Some people taking XELJANZ/XELJANZ XR can get tears in their stomach or intestines. This happens most often in people who also take nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or methotrexate.

XELJANZ/XELJANZ XR should be used with caution in patients who may be at increased risk for gastrointestinal perforation (e.g., patients with a history of diverticulitis), or who have a narrowing within their digestive track. Patients should tell their healthcare provider right away if they have fever and stomach-area pain that does not go away or a change in bowel habits".

http://www.pfizer.com/news/press-release/press-release-detail/pfizer_announces_fda_approval_of_xeljanz_xr_tofacitinib_citrate_extended_release_tablets_the_first_and_only_once_daily_oral_jak_inhibitor_treatment_for_rheumatoid_arthritis

I was "born" constipated, so the meds I am on that cause constipation are usually a pain in the butt. I live on prunes, all-bran original, lots of water, fruits and veggies, and sometimes stool softeners. I presume that I have GI malformations, etc. like many do but that has been at the bottom of my condition/worry list. I figured Xeljanz was conflicting with my normal constipation issues. I have enough appointments and tests coming out of my ears without a GI appointment. I'll see later.

Diabetes is also highlighted with Xeljanz use since we are more prone to infections. Although Xeljanz is not a biologic, it does spread infections quickly. That is why the Rheumatologist in the ER took me off the Xeljanz
immediately, since my test results came back with Sepsis.

I had the pain in my temple area down to the neck for a week or two but it didn't affect my eye at any time.

I have to correct myself. I was at my Rheumy's last week and I also went for exrays on my hips an knees.
He mentioned that there was another JAK inhibitor like Xeljanz coming down the pipeline. It didn't have a name yet, just a number. I didn't ask which company. Take Care Peggy :) and I hope that that pain stays away and you do not have any other problems with Xeljanz.
Type 1 Diabetes - Severe Rheumatoid Arthritis(RA) - Asthma - Hypounawareness - secondary Raynauds - Osteoarthritis - Dry Eye - other stuff

Coversyl - Pantoloc(as irritation preventative) - Levemir - Indomethacin - long acting Morphine - short acting Morphine - Salbutamol - Prednisone - Humalog - Tears Naturelle II - Aspirin(81 mgs.) - Cod Liver Oil Caps - Vit D other OTC

Post Edited (msOuchie) : 12/4/2016 2:10:41 PM (GMT-7)


psbg
Regular Member


Date Joined May 2012
Total Posts : 280
   Posted 12/4/2016 3:57 PM (GMT -6)   
Msouchie I ended up at hospital this morning. X-rays shows I'm embarrassed to say backed up with bowel. Even though I had been going every day wasn't enough I guess. I was mortified. So I came home with magcitrate to drink. You can bet I will be drinking benefited from now on. That kind of pain is no joke.hpoe your day goes good thanks for the talks and the info.
Hugs to ya
Peggy

msOuchie
Regular Member


Date Joined Dec 2011
Total Posts : 453
   Posted 12/6/2016 12:04 AM (GMT -6)   
That's so good to hear that they found the problem, Peggy. Smart idea going to the ER. Oh, it doesn't matter what the issue is, as long as it can be solved. You sure don't need no blockages with Xeljanz. Are you feeling better today? I sure hope so. Thanks for letting us know your update on the situation.
Type 1 Diabetes - Severe Rheumatoid Arthritis(RA) - Asthma - Hypounawareness - secondary Raynauds - Osteoarthritis - Dry Eye - other stuff

Coversyl - Pantoloc(as irritation preventative) - Levemir - Indomethacin - long acting Morphine - short acting Morphine - Salbutamol - Prednisone - Humalog - Tears Naturelle II - Aspirin(81 mgs.) - Cod Liver Oil Caps - Vit D other OTC

psbg
Regular Member


Date Joined May 2012
Total Posts : 280
   Posted 12/6/2016 8:09 AM (GMT -6)   
Was feeling better but pain in the upper abdomen comes and goes again. Although not as severe I'm at my dr office. Can't take a chance on that kind of pain again. Will update later. Hugs
Peggy
Rhuematoid Arthritis, degenerative joints, herniated disc's in back and neck. Changed from Cimzia to Orencia injections now off Orencia started Rituxan infusion as of May 2014, Plaquenil 400 mg daily, 20 mg. prednisone, hydrocodone for pain. And like most of you I fight with fatigue regularly...

celebrate life
Veteran Member


Date Joined Dec 2014
Total Posts : 2066
   Posted 12/8/2016 2:00 AM (GMT -6)   
Hey Peggy,
I was just reading about this very issue on the prostrate cancer forum. It was a thread about constipation because of radiation, but I thought there was a lot of good information about constipation and avoidance of blockages all together. Nothing embarrassing there. Serious business we all deal with as we age or from medication side effects. Check it out if you get a chance.
Be well!
Beth
DH 52@dx 11/2010
PSA:1983 G 4+5=9 extensive bone mets and lymph nodes
Docetaxel, Zytiga 2012 Smarium, Xtandi 2013 xofigo 2014
Cabazitaxel, Zytiga rerun
Ongoing:xgeva + Lupron
RT sacrum X 10
PSA 1/15 100
2/15 liver mets
DRibbles trial 3/15 PSA:259
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docetaxil PSA 7/15:1054 9/15:921;12/15:1008 retry xtandi
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psbg
Regular Member


Date Joined May 2012
Total Posts : 280
   Posted 12/8/2016 3:10 PM (GMT -6)   
Well had ultra sound done showed nothing. Did it over while abdomen. But yet my pain is still coming and going. Don't really know what to do from here. Will wait to see what my Dr says about the test I. Two weeks when I go back. Until then I guess I'll suffer. Say a prayer for me friends. Hugs to you all
Peggy
Rhuematoid Arthritis, degenerative joints, herniated disc's in back and neck. Changed from Cimzia to Orencia injections now off Orencia started Rituxan infusion as of May 2014, Plaquenil 400 mg daily, 20 mg. prednisone, hydrocodone for pain. And like most of you I fight with fatigue regularly...
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