Will insurance pay for weekly Humira

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survivor49
Regular Member


Date Joined Oct 2007
Total Posts : 241
   Posted 12/8/2008 4:10 PM (GMT -7)   
I have United health care, with medco for rx and i think that my gi is going to bump me ot weekly humira. how difficult is this to get the insurance co to pay for?

Aimee =)
Veteran Member


Date Joined Jun 2004
Total Posts : 1020
   Posted 12/8/2008 4:21 PM (GMT -7)   
Mine has not had an issue with it, surprisingly! He just changed the dosage requirements.

hspenser
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Date Joined Dec 2005
Total Posts : 544
   Posted 12/8/2008 5:58 PM (GMT -7)   

why do they need to know?  I started out with two injections every other week...now my doctor has moved me to 1 shot every week....the math is the same only the schedule has changed.

We didn't have to change the script....I was the only one who had to adjust anything.


dx IBS 1999   UC 2000   CD 2001
Tested BIOGEN TYSABRI (gave me 2 years of remission)
tried Naltrexone Jan. 19, 2007 Stopped the Naltrexone July 28th...started Humira Aug 31st, 2007...current dose one shot every week. Also nightly dose of mesalamine.
Surgery Nov 4th, 2008 removed 30 inches of small bowel.
 Crohns is currently active and has been since April of 2005
52 yrs old


Aimee =)
Veteran Member


Date Joined Jun 2004
Total Posts : 1020
   Posted 12/9/2008 10:05 AM (GMT -7)   
hspenser said...

why do they need to know?  I started out with two injections every other week...now my doctor has moved me to 1 shot every week....the math is the same only the schedule has changed.

We didn't have to change the script....I was the only one who had to adjust anything.


Most people only take 1 injection every other week - not 2. So if you have needed 2 shots a month, and now need 4, your script has to change.

I used to take 1 every two weeks and he needed to rewrite it to 1 every week, thus upping the dosage to 2 boxes a month.


Jillybean1887
Regular Member


Date Joined Jan 2007
Total Posts : 56
   Posted 12/9/2008 10:46 AM (GMT -7)   

Most MD's just have to write a letter to the Insurance Company and generally it gets approved.  That's what my MD did and it works fine.

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


Pibbin
Regular Member


Date Joined Apr 2008
Total Posts : 163
   Posted 12/9/2008 8:28 PM (GMT -7)   
I too have UHC with Medco. Unfortunately, when my dr increased my Humira to weekly this spring, UHC denied it both initially and after appeal. They were also horrid to deal with -- supposedly never received the dr's letter that I sent certified mail (and had a confirmation signature for!), then misplaced faxes, disconnected phone conversations etc. Make copies of everything and document all calls with names of who you are speaking with. I hope you have better luck.

BUT, the silver lining... if you are denied, Abbott's patient assistance program will provide you with the medication, assuming you are not a billionnaire who can afford the steep cost out of pocket. They were absolute angels... they promptly sent me a 4 month supply.
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, Proctofoam, Entocort, Remicade, Humira
10/10/08 colon removed, temporary ileostomy
11/10/08 FINALLY off prednisone after 18 months
2nd of 3 surgeries planned for Jan '09 to form j-pouch


hspenser
Veteran Member


Date Joined Dec 2005
Total Posts : 544
   Posted 12/9/2008 8:48 PM (GMT -7)   
Aimee =) said...
Most people only take 1 injection every other week - not 2. So if you have needed 2 shots a month, and now need 4, your script has to change.I used to take 1 every two weeks and he needed to rewrite it to 1 every week, thus upping the dosage to 2 boxes a month.
I have always taken two shots every other week ...so this is equal to four shots in four weeks   or the equivelent of four shots a month...now I take 1 per week, but that still equals 4 shots per month.....not sure where you came up with your math....but trust me it works and I do not need to change my script.
dx IBS 1999   UC 2000   CD 2001
Tested BIOGEN TYSABRI (gave me 2 years of remission)
tried Naltrexone Jan. 19, 2007 Stopped the Naltrexone July 28th...started Humira Aug 31st, 2007...current dose one shot every week. Also nightly dose of mesalamine.
Surgery Nov 4th, 2008 removed 30 inches of small bowel.
 Crohns is currently active and has been since April of 2005
52 yrs old


Pibbin
Regular Member


Date Joined Apr 2008
Total Posts : 163
   Posted 12/9/2008 9:03 PM (GMT -7)   
According to multiple doctors and the insurance company, the FDA approved prescription after all the loading doses is one shot every other week, or 2 per month. If it is prescribed weekly, or 4 shots per month, the prescription needs to be rewritten and most insurance companies have to authorize the change.
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, Proctofoam, Entocort, Remicade, Humira
10/10/08 colon removed, temporary ileostomy
11/10/08 FINALLY off prednisone after 18 months
2nd of 3 surgeries planned for Jan '09 to form j-pouch


hspenser
Veteran Member


Date Joined Dec 2005
Total Posts : 544
   Posted 12/10/2008 5:28 AM (GMT -7)   
Pibbin said...
According to multiple doctors and the insurance company, the FDA approved prescription after all the loading doses is one shot every other week, or 2 per month. If it is prescribed weekly, or 4 shots per month, the prescription needs to be rewritten and most insurance companies have to authorize the change.

I started out with 4 plus shots per month....and no issue with the insurance.  I have two thwr friends who also take or did use Humira...so thing 4 plus shots per week.  A lot of this may depend on the area and the doctors....I was told by Doctor that mine was the normal dose.   Survivor doesn't say what his/her dose is...so certainly if the doctor increases the amount of shots per then a new script is required.....can't imagine an insurance company balking at such change, but we all know how strange insurance companies can be......
 
I was on tysabri years ago....I was a lab rat for it...it worked very well....and not only did my insurance company not have to pay for it....they didn't have to cover lots of the tests, treatments and doctor visits that I went through for over a two year period.  They acknowledge that I was on it...they admit that it "appears" to have helped me.....they recognize that they may have saved money while I was on it....but will they approve me for it now....NO WAY.   Go figure
dx IBS 1999   UC 2000   CD 2001
Tested BIOGEN TYSABRI (gave me 2 years of remission)
tried Naltrexone Jan. 19, 2007 Stopped the Naltrexone July 28th...started Humira Aug 31st, 2007...current dose one shot every week. Also nightly dose of mesalamine.
Surgery Nov 4th, 2008 removed 30 inches of small bowel.
 Crohns is currently active and has been since April of 2005
52 yrs old


survivor49
Regular Member


Date Joined Oct 2007
Total Posts : 241
   Posted 12/10/2008 10:53 AM (GMT -7)   
i am on 40 mg every other week
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