Humira? Remicade? Insurance woes.

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ISF13+
Regular Member


Date Joined Jun 2009
Total Posts : 202
   Posted 8/28/2009 7:01 AM (GMT -7)   
So my GI doc wants me to increase my Humira injections from every other week to EVERY week.  My insurance company doesn't want to pay for that.  Evidently every other week is reasonable to them but not every week.  They, as in the insurance company, want me to go on the Remicade which I thought was more expensive than the Humira.  At any rate, I'm due for my next Humira injection on Tuesday.  The pharmacy called yesterday to tell me that they won't be shipping me the Humira because if I can't do a weekly injection, then my GI doc wants to swith me over to Remicade.  In the meantime, I'll be skipping my usual dose of Humira drug which will most likely cause a major flare up.  I don't understand the logic.  I would have thought that I would be better off doing my next schedule Humira injection while my doc and insurance company sort things out.  Am I missing something here?  My past experience has always been that anytime my doc has tweaked with my medications, I come out of remission and flare.  We're still trying to get me back into remission from this happening last year.  So, as you can see, I'm a bit nervous to have things interrupted and changed again.
Crohn's Disease. 
Diagnosed 13+ years ago. 
Been in remission for short periods of time but each time I come out of remission my disease seems to have spread.  No longer isolated in my ileum, now from stomach down to rectum. 
Current Medications for the Crohns:  Humera 40mg injections every other week, Imuran 150mg, 3xday, Hyomax, Welchol 625mg, Vancocin HCI 125mg (generic for Vancomycin), 4xday for C-Diff, Calcium, Acidophilus & Potassium
Previous Medications I've been on:  Asocal, Pentasa, Cipro, Prednisone, Flagyl & Entocort


medchrt1
Veteran Member


Date Joined Sep 2005
Total Posts : 517
   Posted 8/28/2009 10:14 AM (GMT -7)   
Abbott http://www.rxabbott.com/pdf/humira.pdf is clear that it can by every week for RA (section 2.1) without methotrexate, dont know why its every other week for crohns but the dose is in section 2.3 of the .pdf file. Reading this,I would think that every week is not out of the question. so when you suggest you are skipping a dose would mean you also have RA or the doc prescribed for every week. If its the either then its in your interest have the doc tell the insurance company this is the dose and they should pick up the tab. So its just the insurance issue. I looked at your other meds to see if the amount has the the insurance company balking, but as you mentioned the remicade is not cheap. Is the welchol for diabetes? You have an interesting combination of drugs now. I have to lean towards your concern, and would say that you would like to be consistent for another few months.

Becky77
Veteran Member


Date Joined Dec 2005
Total Posts : 1768
   Posted 8/28/2009 12:16 PM (GMT -7)   
Insurance companies can be such a pain. I just don't get it sometimes...if a doctor deems it necessary for you to take a medicine, I don't think the insurance should have grounds to say no to covering it...yet they're allowed to, and do it quite often. Would they rather you not be treated and be hospitalized and require surgery?

I hope everything works out...let us know when a decision is made on what's going to happen long term!
Becky

31 yr old female-dx with Crohn's in '97 after emergency resection and appendectomy, 2nd resection '05
Currently on Humira, Prilosec, Effexor, Seroquel, Calcium, Vit D, sublingual B12; phenergan, ultram, clonazepam as needed


ZenaWP
Veteran Member


Date Joined Aug 2007
Total Posts : 884
   Posted 8/28/2009 12:54 PM (GMT -7)   
Neither my GI or rheumy have been able to get Humira approved weekly for any of their patients.  They say it's the insurance companies that are fighting it.  So, you aren't alone, ISF.  As for them not wanting to ship the Humira if you are switching, some docs want you to wait a month in between Humira or Cimzia and Remicade.  When I did a clinical trial for Cimzia, I had to be off of the Remicade for one month first.  Now, when switching from Cimzia to Humira, they only made me wait the normal 2 weeks.  So, it depends on the doctor and possibly the insurance company as well, but you should have a little lapse in between the two, even though that may make things worse at first. 

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


ISF13+
Regular Member


Date Joined Jun 2009
Total Posts : 202
   Posted 8/28/2009 1:15 PM (GMT -7)   
"even though that may make things worse at first.", that's the part I'm afraid of.  Thanks for your input - all of you.  I now at least know I'm not going crazy although it still irritates me. 
Crohn's Disease. 
Diagnosed 13+ years ago. 
Been in remission for short periods of time but each time I come out of remission my disease seems to have spread.  No longer isolated in my ileum, now from stomach down to rectum. 
Current Medications for the Crohns:  Humera 40mg injections every other week, Imuran 150mg, 3xday, Hyomax, Welchol 625mg, Calcium, Acidophilus & Potassium
Previous Medications I've been on:  Asocal, Pentasa, Cipro, Prednisone, Flagyl, Vancomycin & Entocort
"LIFE IS NOT HOW YOU SURVIVE THE STORM, BUT HOW YOU DANCE IN THE RAIN...."

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