Humira Approval?

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Regular Member

Date Joined Jan 2007
Total Posts : 200
   Posted 8/28/2007 8:34 AM (GMT -6)   
My doctor has decided it is time for me to try Humira. My insurance is Blue Cross Blue Shield and per their instructions they have to approve for me to take this medicine.
I was just wondering if anyone else had to go through this process and how long it takes. Also, they mentioned I might have to pay a startup fee, has anyone had to do this with Humira?

22 year old female
Crohn's Disease (diagnosed 2006) taking Pentasa, Flagyl and awaiting approval from insurance to start Humira
Polycystic Ovarian Syndrome
Anxiety Disorder
Psoriatic Arthritis
Using Darvocet & Lortab for Pain
Tigan for nausea

Veteran Member

Date Joined Feb 2006
Total Posts : 842
   Posted 8/28/2007 8:46 AM (GMT -6)   
I work for Blue Cross/Blue Shield's Medicare Part D drug plans. Assuming the prior authorization process is the same for their regular plans as well, you have your doctor call in, once we get the request, it takes 24-72 hours to review the case. If your doctor asks for an expedited authorization, we get back to you within 24 hours
Crohn's Disease for a year and counting
Imuran: 150mg
Remicade: Every 6 weeks 10mg/kg, next infusion: July 26th
Dicyclomine and hyoscamine for intestinal cramping and spasms <--This link will be changing, but for now it works!

New Member

Date Joined Aug 2007
Total Posts : 9
   Posted 8/28/2007 5:49 PM (GMT -6)   
try using the "search" feature on this site to search for other posts about Humira and/or insurance authorizations, this topic has come a lot in the past.

Regular Member

Date Joined Jun 2007
Total Posts : 86
   Posted 8/28/2007 7:24 PM (GMT -6)   
Lauren, I have Blue Cross and I'm going through the exact same thing right now. According to the GI, Blue Cross approved me, but for some reason my pharmacy can't seem to get that information. So here I wait....
Dx Bipolar disorder, anxiety, insomnia '00
Appendectomy Nov '01
Dx Chron's summer '05
6MP 75mg, Vicodin as needed, Neurontin, Wellbutrin XL, Asacol 12pills/day, Ambien, Multivitamin w/folic acid, Calcium, B12, Vit E

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Regular Member

Date Joined Aug 2007
Total Posts : 350
   Posted 8/28/2007 7:47 PM (GMT -6)   
I just got mine approved today. I pay $45 a month and there paying $3826. All I can say is wow
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 (22 years old 165lbs). Starting HUMIRA 9/10/2007.

Veteran Member

Date Joined Mar 2005
Total Posts : 4305
   Posted 8/29/2007 3:55 AM (GMT -6)   
Lauren yes I had to get approval from my insurance as well it took about two weeks to get it.I was first put on Humira back in 2004 but when I devorced I lost my insurance that my ex had on me.So when I moved back to my home town(different state)I applyed for what we call TENN_CARE,it is a state funded insurance for people that have a chronice illiness and for children when perants can't afford insurance through there work.Don't get me wrong you have to pay for it but most people on it don't have co-pays and if they do it's $3.00 for name brand drugs and nothing for generice.There is no co-pay on doctor visits or hospitals.So any way I had to come off of it untill I was approved for this insurance (I'm also on medicade)so I have been back on humira for all most two year's now.I hope that I will continue the use of humira because it has worked well for me.Let us know how you are doing on it and it you have any questions please ask I will answer them for you.

Regular Member

Date Joined Dec 2006
Total Posts : 371
   Posted 8/29/2007 7:07 AM (GMT -6)   
Sending in my paperwork today. Wish me luck
Female Dx'ed with Crohns Disease in 1992
Been on every med for crohns that exists
Several Fistula surgeries
Dx'ed with Colon Rectal Cancer March 2007
Dx'ed with Stage 2 Vulvar VIN
On Chemo and Radiation for 6 weeks

Regular Member

Date Joined May 2007
Total Posts : 148
   Posted 8/29/2007 8:44 PM (GMT -6)   
Lauren- I am going through the same thing. My doctor put in the prescription for pre-authorization, BCBS denied it, my GI sent in the documentation of 8 months of pred and an allergic reaction to the Remicade and they approved the STARTER PACK only for the Humira. Now the GI has to call in again to request a separate preauthorization for the refills. When I asked the insurance agent whether they were aware that this was not a drug you took once (they authorized "1 fill"), she said "no." Kind of scarey that folks totally unfamiliar with these drugs are making decisions about them. In the mean time we spend hours on the phone trying to straighten it all out.....
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