Humira Weekly??

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porkysgal
Regular Member


Date Joined Jan 2008
Total Posts : 95
   Posted 4/18/2008 3:08 PM (GMT -7)   
 
Is anyone taking Humira weekly and if so is your insurance covering it weekly.   I am taking bi-weekly, with a $30.00 copay a month for the two shots and it seems to only be good for about a week.  I called my insurance and they said it would be covered but  my doc office is saying FDA is only approving for Crohns bi-weekly ,  where it is approved for RA weekly and that maybe my insurance did not realize I was asking for Crohns.
Just curious about others, if you have any input I would appreciate so I can share with my doc office.
 
thanks
 
Deb
 

Mac_Gyver
Regular Member


Date Joined Aug 2007
Total Posts : 350
   Posted 4/18/2008 3:18 PM (GMT -7)   
I was suppose to start weekly but insurance denied my coverage. I appealed and they finally approved it but while it was beiing approve they cancel my RX. By them doing that I was off it for to long, 2 months, and doctor said it would no longer have any effect.
If you have UHC be ready for a fight for approval
Symptoms Of Crohn's June of '06 (21 years old 285lbs). Colonoscopy in Jan '07 no sign of Crohn's.
Surgery for a Fistula in April '07, diagnosed suggestive Crohn's in May '07. August '07 small bowel follow
through, diagnosed with Crohn's (23 years old 180lbs). On prednisone and will be starting Tysabri Soon.
============================================


Pibbin
Regular Member


Date Joined Apr 2008
Total Posts : 163
   Posted 4/18/2008 3:23 PM (GMT -7)   
Uh oh, I have UHC for insurance, and my dr just increased my dose to weekly. I am waiting to hear if it has been approved -- the pharmacy is taking the lead with requesting authorization.
Dx Mild Proctitis 7/06 at age 33, Dx Severe Pan Colitis 5/07, Dx Crohn's Colitis 10/07
Failed Asacol, Lialda, 6-MP, Canasa, Rowasa, Entocort, and Remicade
On Humira since 1/08 with promising results, but can't get below 5mg Prednisone
Take Tylenol #3 as needed when not in close proximity to a bathroom.
Currently on 40mg Prednisone again since mid-March flare, ack
4/9/08 Humira dose increased to 40mg/week, Start slow Pred taper


Mellie
Regular Member


Date Joined Mar 2008
Total Posts : 110
   Posted 4/18/2008 4:05 PM (GMT -7)   
I take Humira every other week but my copay is $100 a month...Optima Insurance. Abbott discount card..financial assistance by Humira..could help. Check with the Humira nurses...
Diagnosed with Crohns/Colitis in 2004. Currently taking Azulfidine 500 mg/3 x 3 day, Synthroid. Have had joint complications such as pyroderma gangrenosum in ankles as complication of IBD.


dragonfly137927
Veteran Member


Date Joined Sep 2006
Total Posts : 2527
   Posted 4/18/2008 8:01 PM (GMT -7)   
i have UHC and began humira 9-07. In November my gi increased me to weekly. It took 7 full dayys for the approval and my GI did initially get a denial on the weekly dosing. He began with the letter to medco...it is who uhc typically uses for mail away meds and meds such as humira...he started the process on 1 monday then after denial for the increase.and more work on his end the following monday it went thru. My copay remained the same since most flat rate copays are based on 30 day dosing unless you have a plan where you pay a certain % your copay shoulf remain the same.
Dx with Crohn's 1987, symptoms as early as 1984.
Temp iliostomy February 2007, reversed June 2007, Ovarian cysts, migraines, allergies (incl food allergies) , oral allergy syndrome (diff than true food allergies), Asthma, Gall Bladder removed 1999, Inguenal hernia 1987
 
 
 


Faizi
Regular Member


Date Joined Oct 2006
Total Posts : 451
   Posted 4/18/2008 8:22 PM (GMT -7)   
We also have UHC. Medco is the problem. Things were fine until Medco came into the picture. The hardest part is the confusion of misinformation. Being told, "Yes, it is approved for the two shots" and, later, "She is only approved for one shot every two weeks." Since I was under the misinformed impression that the two shots every two weeks had been approved, I was giving my daughter two shots every two weeks. Suddenly, I was told, "Oh, no. She has exceeded her limits and can have no more."

So, she missed several doses. I was told the appeal would take thirty days to process and, in the meantime, she could have no Humira whatsoever. I finally was connected to a UNC supervisor who has been working hard to try to expedite the appeal faster. She did get an override so that my daughter could have one shot every two weeks. My daughter ended up in the ER, of course; back on Prednisone; and her abscess and fistula conditions worsened.

It is nearly impossible to pin Medco down on anything. You never know when you are being given correct or incorrect information. I always call two or three times on the same question in an attempt to verify what I have been told. But, I always get screwed in the end, no matter what.

I do realize that Humira is a very expensive medication. The last I knew, the cost was about sixteen hundred dollars for the two shots a month. Double that is far more than I make in a month. But, we are not playing around here. My daughter, like many others, requires the medication. It is not like we simply decided we wanted to give it a whirl. She failed everything else -- including Remicade.

Sorry to go on and on. But just wanted to add to the general opinion that Humira in double doses is a tough row to hoe when it comes to insurance approval.

Jillybean1887
Regular Member


Date Joined Jan 2007
Total Posts : 56
   Posted 4/19/2008 8:42 AM (GMT -7)   
I take it weekly and at first Medco/Acredo would not support that and then my doctor fought it and now I get a 90 day supply for $40.00. Finally, something went my way.

Jill
Diagnosed with Crohn's Disease in 2000
Bowel Resections 6/05, 11/05 & 7/06 (removal of terminal ileum and appendix)
Humira 40mg. every week
Percocet 10/325mg
Codeine 30 mg.
Cymbalta 30 mg.
Xanax 0.50mg
Phenergan 25 mg.
Zofran 8mg.
Hydroxine 25mg.
B12 Injections monthly


sr5599
Veteran Member


Date Joined Aug 2007
Total Posts : 1202
   Posted 4/19/2008 8:54 AM (GMT -7)   
I went through two appeal processses with BlueCross BlueShield and was denied weekly... I had been on weekly for a month duing a trial and it was better, but still not great.
--39 year old female, dx as UC in '04 (1st symptoms in '03), switched to Crohn's in '05, 1 fistula, crohn's colitis, limited to large intestine
--rejected (reaction/didn't work): Asacol, AZA, 6-MP, MTX, Remicade, Humira, prednisone
--stuck on methylprednisolone, tried Prochymal in Phase III study (can't wait til it's approved!)
--started Tysabri 3/21/08
--single mom to 10-year-old girl


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 4/19/2008 11:47 AM (GMT -7)   
Sometimes an estimated cost of treatment without the med is helpful. Like if your doc says "without Humira I anticipate 2 hospitalizations/month at $5000/hospitalization. It helps the insurance company do the cost benefit analysis and realize that it is better for them to approve the Humira.
26 Year old married female law student.  Diagnosed w/ CD 3 years ago, IBS for over 10 years before that, which was probably the CD.  I am sort of lactose intollerant too but can handle anything cultured and do well w/ lactose pills and lactaid.  For crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn.  I also have bad acid reflux and have been on PPI's since age 13.  I have been through prilosec, prevacid, and nexium.  Currently I am on Protonix in the morning and Zantac at night.  I alos take a birth control pill to allow some fun in my life.
 
 


AR23
New Member


Date Joined Apr 2008
Total Posts : 2
   Posted 4/22/2008 7:53 AM (GMT -7)   
I started Humira weekly six weeks ago and it is not working. Medco is a mess, but they got it right finally. I also missed a shot when I went from the open label study (after being in the clinical trial) thanks to Medco.

Pampers
Regular Member


Date Joined May 2007
Total Posts : 76
   Posted 4/22/2008 10:00 AM (GMT -7)   
I take it weekly, with no fight. I have Medco insureance but for some reason get my meds through Acredo. Why I dont know, but it was a painless transition for me onto Humira.
DX with UC 8 years ago/Re-Diagnosed with Crohn's 6/26/2007
Canasa / 1 per day
Azathioprine / 100 MG Day
Lialda(new) 2 per day
Rowasa / 1 per day
Humira
 
Tried:
Asacol / 12 per day
Levaquin 1 per day
Flogyl 1 per day
Prednizone / 40 MG Day( finished taper!!!) 
Colazal/ 9 per day
Entocort/ 3 per day
 


Pibbin
Regular Member


Date Joined Apr 2008
Total Posts : 163
   Posted 4/29/2008 11:24 AM (GMT -7)   
UHC/Medco just denied the authorization for weekly Humira. I am riding my GI's office to get the appeal started ASAP. Anyone know what my options are for getting my meds in the meantime?

I would consider paying out of pocket on a credit card (ouch) if I knew insurance would reimburse me if appeal is accepted, but I can't afford to otherwise. I called MyHumira, and they can only offer me the patient assistance program if the appeal takes more than 30 days or is denied.

I am due for a shot tomorrow, and I will be so disappointed if I start to decompensate due to stupid bureaucratic insurance crap. Sigh.

Any suggestions?
Dx Mild Proctitis 7/06 at age 33, Dx Severe Pan Colitis 5/07, Dx Crohn's Colitis 10/07
Failed Asacol, Lialda, 6-MP, Canasa, Rowasa, Entocort, and Remicade
On Humira since 1/08 with promising results, but can't get below 5mg Prednisone
Take Tylenol #3 as needed when not in close proximity to a bathroom.
Currently on 40mg Prednisone again since mid-March flare, ack
4/9/08 Humira dose increased to 40mg/week, Start slow Pred taper


YMAMOT
New Member


Date Joined Sep 2008
Total Posts : 1
   Posted 9/23/2008 3:41 PM (GMT -7)   
I was diagnosed with Crohn's disease in 2005.  I have been on Colazol, Rowasa, Prednesone, Asacole, Remicade Treatments...and in November of 2007 my GI put me on HUMIRA one injection bi-weekly.  This summer, I started having a really bad flair up, and I ended up in the ER once, treated for dehydration and released, and the following week ended back in hospital for a five days.  The last time I was in the hospital my GI increased my HUMIRA to one injection daily, put me on Hyomax twice a day, and Prednesone.  I had enough shots at home to compensate for 3 weeks (being I was in the hospital and they ordered me one in while I was there), and I thought through the mail in pharmacy I have to go through for this drug through Anthem that my prescription had been approved.....and they even set up shipping for this new script, but when the pharmacy went to ship it, they called and said it had not been approved through Anthem. Now shouldn't they have already known that two weeks in advance when I called them about the new script instead of waiting until the last minute when I needed this medication to tell me???? The original script I had on file with them was automatically voided out when the new script was sent in....so I was HUMIRALESS.  In the mean time Anthem totally denied the script for one shot a week.  My doctor's office is trying to appeal this, but it REALLY UPSETS ME as for THREE WHOLE WEEKS I experienced the best QUALITY OF LIFE THAT I COULD IMAGINE.....NOT ONE SIGN OF THIS TERRIBLE DISEASE, NOT ONE WORRY about BEING SOMEWHERE WITHOUT HAVING TO WORRY "WHERE IS THE BATHROOM," I COULD ACTUALLY EAT FOOD AND NOT HAVE TO WORRY THAT I WAS GOING TO BE SICK, I DID NOT HAVE LOOSE STOOLS AT ALL,  I DID NOT HAVE CRAP RUNNING DOWN MY LEG BECAUSE I COULDN'T CONTROL MY BOWELS TO GET TO THE BATHROOM IN TIME, I DID NOT HAVE A MUCUSY UNCONTROLLABLE DISCHARGE, I DID NOT HAVE BLOODY DISCHARGE, I HAD NO PAIN, NO CRAMPING, AND NO BLOATING, AND I WAS FULL OF ENERGY....And then this past Saturday night I got violently ill again....and today (three days later) the pharmacy finally got me a bi-weekly supply going again, so I did have a shot today.  This evening I feel a little better.  The stress is not helping any, and NOBODY DESERVES TO GO THROUGH THIS IF ONE SHOT EVERY WEEK WILL HELP!  What is wrong with insurance companies?  If a doctor says you need a certain medication, do they think he made it up?  My GI had already faxed two written letters to ANTHEM indicating WHY I need this weekly.  Now we have to go through an appeal, and I feel CHEATED OUT OF LIFE OVER THIS...AND I AM ABSOLUTLEY DEVISTATED!!!  Who are the doctor here? 
 
I am praying this gets turned over in MY FAVOR!!!  I want to feel normal again!!!!
 
 

ZenaWP
Veteran Member


Date Joined Aug 2007
Total Posts : 884
   Posted 9/24/2008 9:11 AM (GMT -7)   

porkysgal, my Humira also wears off after a week but both my GI and Rheumy say they've tried with several patients and can't get it approved weekly, which I don't understand since others here do it.  Apparently a new study has come out showing that there is no benefit to weekly dosage, so it's making it even harder now to get it approved weekly.  So, I'm considering switching back to Cimzia to see if it will help more.  I hope you can figure out how to get it approved weekly! 

Pampers, Accredo handles the specialty drugs for Medco.  All of my meds except for Humira come from Medco, but the Humira comes from Accredo.   


Crohn's Disease, Acid Reflux/Gastritis, Hashimoto's Thyroiditis, Endometriosis, Arthritis, Depression/Anxiety.  Too many meds to list them all.  =) 

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