Article about insurers not wanting to pay for Remicade and Humira

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ks1905
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Date Joined Sep 2005
Total Posts : 5090
   Posted 3/6/2008 5:13 PM (GMT -6)   

Although Remicade and Humira Are Being Increasingly Prescribed for Crohn's Disease and Ulcerative Colitis, Insurers Are Subjecting Both Drugs to Multiple Cost-Control Strategies

Posted on: Tuesday, 4 March 2008, 09:01 CST

WALTHAM, Mass., March 4 /PRNewswire/ -- Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that although gastroenterologists are increasingly prescribing Centocor/Schering-Plough/Mitsubishi Tanabe's Remicade and Abbott/Eisai's Humira for the treatment of Crohn's disease and ulcerative colitis, a high proportion of managed care organizations (MCOs) subject both drugs to multiple cost-control strategies to keep costs down and limit the use of the two biologic therapies.

http://www.redorbit.com/news/health/1280730/although_remicade_and_humira_are_being_increasingly_prescribed_for_crohns/index.html?source=r_health

--Keith


DX'd with Pan-Colitis June 2005
Current Status: Flaring since May 2007
 
Current Meds:  50 mgs 6-mp, Colocort, Oral Cyclosporine (250 mgs), Hyoscyamine .375 mgs
Supplements:  Forvia multi-vitamin
 


princesscolon
Veteran Member


Date Joined Apr 2006
Total Posts : 733
   Posted 3/6/2008 6:29 PM (GMT -6)   
Thank you for this. I was just ripping my hair out over the nonsense I am going through to get my Humira. Hopefully there will be a change for the better someday. :( It's sad how insurance and money affects how healthy we can be.
Diagnosed with Left-sided Ulcerative Colitis 1995 at 15, Tried: Prednisone, Rowasa & Hydrocort. Enemas, Proctofoam, Sulfasalazine, Asacol, Probiotics, Fish Oil, Canasa, Enotcort, Colazol, Anamantle, etc... had almost recto-vaginal fistula in 2004, put on Remicade, August 2007:Increased Remicade dosage-700mg every 6 weeks,diagnosed w/ Psoriatic Arthritis & Fibromyalgia Current meds: Remicade 700mgs every 6 wks (had reaction, will start Humira Feb 11) Clorazepate, Proctofoam HC, Glucosamine 500, Vitamin B, Lomotil,  Tylenol pm, Lyrica for Fibromyalgia started 1/17/08


jujub
Forum Moderator


Date Joined Mar 2003
Total Posts : 10407
   Posted 3/6/2008 6:55 PM (GMT -6)   
At the cost of these things, I don't think it's unreasonable for them to require us to try the older, less expensive meds first or to get pre-authorization. My co-pay is the same as for any other specialist visit. My remi has to have a new pre-auth each year, but they always take care of it on time.

It's frustrating when we have to do extra paperwork and jump through hoops, but looked at from the global view, it makes sense. The costs of new drugs being developed with genetic engineering, including these, is helping send healthcare costs through the roof. Unfortunately, we need them to function.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Asacol, Rowasa, Pentasa, Prednisone, Entocort, Azathioprine
Colazal,  Remicade, Nature's Way Primadophilus Reuteri.
In remission since April, 2006. Remicade has been my wonder drug.
 
Co-Moderator UC Forum


princesscolon
Veteran Member


Date Joined Apr 2006
Total Posts : 733
   Posted 3/6/2008 8:11 PM (GMT -6)   
Judy I am not trying to argue, but in your signature it looks like you tried quite a few meds before starting Remicade, which you call your wonder drug... wouldn't it have been better if you could have just taken Remicade in the first place? Also, recently someone posted a study that stated people respond better to starting with the heavy-duty drugs from the start rather than the ASAs and things if I remember correctly. In the end, the insurance might be paying more by avoiding Remicade and Humira because the lousy meds we start with don't work, resulting in more visits to the ER and more doctor visits. I have tried pretty much everything out there. My insurance does not want me to take Humira even though I had reactions to Remicade and I am hanging by a thread here... I don't know if they are forcing me into an illeostomy or what they expect me to do.  Maybe if Remicade and Humira were used more often the price would go down? confused
Diagnosed with Left-sided Ulcerative Colitis 1995 at 15, Tried: Prednisone, Rowasa & Hydrocort. Enemas, Proctofoam, Sulfasalazine, Asacol, Probiotics, Fish Oil, Canasa, Enotcort, Colazol, Anamantle, etc... had almost recto-vaginal fistula in 2004, put on Remicade, August 2007:Increased Remicade dosage-700mg every 6 weeks,diagnosed w/ Psoriatic Arthritis & Fibromyalgia Current meds: Remicade 700mgs every 6 wks (had reaction, will start Humira Feb 11) Clorazepate, Proctofoam HC, Glucosamine 500, Vitamin B, Lomotil,  Tylenol pm, Lyrica for Fibromyalgia started 1/17/08

Post Edited (princesscolon) : 3/6/2008 7:15:35 PM (GMT-7)


jujub
Forum Moderator


Date Joined Mar 2003
Total Posts : 10407
   Posted 3/6/2008 11:04 PM (GMT -6)   
Actually, in my case, I wouldn't have considered Imuran if the other drugs hadn't failed, and wouldn't have considered Remicade if the Imuran hadn't failed. For me, going from the least possible toxicity to the greater made sense.

I actually had the same problem with Remicade you're having with Humira. My insurance wouldn't cover it until it was approved by the FDA for UC. It sucked, but I know my policy specifically states they don't cover non-approved drugs or treatments. Remicade turned out to be promising enough that the FDA fast-tracked it for UC, and it got released sooner. Maybe a letter-writing campaign to the FDA would encourage them to do the same for Humira?

I totally understand your frustration, I thought I was going to end up having surgery also. I hope it works out for you very soon.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Asacol, Rowasa, Pentasa, Prednisone, Entocort, Azathioprine
Colazal,  Remicade, Nature's Way Primadophilus Reuteri.
In remission since April, 2006. Remicade has been my wonder drug.
 
Co-Moderator UC Forum


Beth75
Veteran Member


Date Joined Jul 2007
Total Posts : 2148
   Posted 3/7/2008 10:32 AM (GMT -6)   
I am on two medications that are 'step therapy', Diovan and Tekturna, the Dr. had to fill out a form to get it approved for me through the ins. co. It is just an added process. However, it is a pain in the butt to deal with, first of all you don't know this when you go to get your script filled so if you don't have any samples or not enough samples left you are SOL. Luckily w/the Tekturna, my ins. co said they would approve one month but I had to have my Doc fill out the form before I could get any refills.

Also, not sure but when can Remicade and Humira go generic? The cost would go down then, right????

At CVS the other day I heard Fosomax is now avail in generic.
Beth, 32
Major Flare Sept/Oct 07 ~ almost in remission
UC dx'd March 2000 (30 cenitmeters as of 2005-proctosigmoiditis)
Azathioprine 200mg 1xday nightly; Calcium and Vit D 500mg 3xday, Multi Vit, Folic Acid 400mg 2xday, Prilosec, Probiotics.
Minimal Change Disease (Kidney Disorder) dx'd Sept 2007
Prednisone 40mg 1xday, Simvastatin 20mg 1xday, Diovan 160mg 2xday. Tekturna 150mg 1xday, Fursomide 20mg 1xday, Fosomax 70mg 1xweek. MCD may be from hypersensitivty to 5ASA drugs.
Pre-Diabetic from Prednisone use - Low carb/sugar diet & exercise.


kb5
Veteran Member


Date Joined Jan 2007
Total Posts : 1015
   Posted 3/7/2008 10:54 AM (GMT -6)   
I had to jump through all the hoops less than a month ago. It took about two weeks to get all the tests done and get insurance to agree. We had to prove that I had tried enough of the opther drugs to warrent needing remicade. Luckily I didn't have to do anything but get blood drawn, chest xray, and answer a few questions. My GI office did everything for me. I understand why. My treatments cost about 10000 each infusion. My doc wanted me on remicade instead of imuran only becuase it is known to work faster and i had been sick for a year already. we couldn't do that beccause of insurance. I had to wait 6 months to give imuran a real try. I don't like that because of insurance I was made to suffer an extra 6 months. I've been on pred for two years It's frustrating but it's the way it works. I see both sides. It's not a great system but I dont have a better solution. I'm just glad they finally said yes.
Kelly, 29

Left sided UC diagnosed 1/98 age 19, Pan colitis diagnosed 1/07
Currently on 4x3 Asacol, started at 60 mg 1/07, 15 mg pred, down to 10 mg 1/11/08...down to 10/5...
75mg Imuran starting 8/23/07---bumped to 100mg 10/8/07--bumped to 125 11/14/07...
Taken off of Imuran temporarily 1/11/08-back on 1/16/08 now at 150mg imuran
waiting to be scheduled for remicade.
Prontonix once daily for acid reflux, zofran twice daily for nausea, darvocet for pain
antispasmodics didn't work.


Beth75
Veteran Member


Date Joined Jul 2007
Total Posts : 2148
   Posted 3/7/2008 12:28 PM (GMT -6)   
I see both sides, I got mad at what I felt was my ins. co. second guessing my treatment (don't mess w/my health man!) but also understand that they want ppl to try less expensive therapies first to see if that helps and prob. helps keep costs down (even though they go up every year).
Beth, 32
Major Flare Sept/Oct 07 ~ almost in remission
UC dx'd March 2000 (30 cenitmeters as of 2005-proctosigmoiditis)
Azathioprine 200mg 1xday nightly; Calcium and Vit D 500mg 3xday, Multi Vit, Folic Acid 400mg 2xday, Prilosec, Probiotics.
Minimal Change Disease (Kidney Disorder) dx'd Sept 2007
Prednisone 40mg 1xday, Simvastatin 20mg 1xday, Diovan 160mg 2xday. Tekturna 150mg 1xday, Fursomide 20mg 1xday, Fosomax 70mg 1xweek. MCD may be from hypersensitivty to 5ASA drugs.
Pre-Diabetic from Prednisone use - Low carb/sugar diet & exercise.


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 3/27/2008 11:49 AM (GMT -6)   
I just can't imagine someone going on remicade or humira for fun. Obviously if you are prescribed it you NEED it or else the patient wouldn't consent. IMHO.
26 Year old married female.  Diagnosed w/ CD 3 years ago, IBS for over 10 years before that, which was probably the CD.  Currently on Pentasa 4 pills/4x day, hysociamine prn, nexium, and ortho evra.  Good times!!!
 
 

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