This has been an ongoing thing with Caremark. Basically, in May, Remicade really stopped being effective for me. We tried to get approval, denied because I'm under 18. Fine, we waited it out, and after awhile, doubled my Remicade dose to 10mg/kg every 6 weeks. Well, that was the end of July, and I had a lupus like reaction. My GI determined that I couldn't take Remicade anymore, and that I really needed to be switched to Humira. We tried again for approval, and it was denied again because I'm under 18, and I didn't have a negative Hepatitis B test on file. Did the Hep B test, that came back negative, of course. Tried again, denied again for being under 18. At this point, I had moved to Minneapolis for college, and had been without effective medication for months. I saw a new GI at the University, and he gave me Humira on the spot, charging it under a different mechanism, so we could avoid the pharmacy issues for now. My GI at home was appealing in the meantime, and I've been counting down the days until my 18th birthday (Oct. 6th). My GI had to step up to a new appeal level, sending a letter of medical necessity, stating that I'll flare without medication, and that this is very urgent. And, I just got a call from his nurse that she received approval! It's been so frustrating, and I know my GI has been frustrated as well, he left me a message earlier today saying that Caremark was being a big pain in the ass
Anyway, I'm just happy to have this ordeal be done with, so I can get my Humira without worrying about
all the odd pharmacy issues.
Crohn's Disease for a year and counting
Humira: got 4 shots on 9/12, still technically waiting for approval from my insurance
Dicyclomine and hyoscamine for intestinal cramping and spasmswww.myspace.com/onebloodonelifehttp://studentwebs.winona.edu/catraun4902
<--This link will be changing, but for now it works!