HUMIRA question

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uofmcamaro
Regular Member


Date Joined Jan 2008
Total Posts : 20
   Posted 6/13/2008 10:34 PM (GMT -6)   
Anyone currently on HUMIRA who had experience with remicade before? Either way. Is HUMIRA pretty effective? Our doctor is telling my wife she needs remicade but he (as far as I know) has said nothing about HUMIRA. Should she try that before remicade? Reason I am asking is because remicade is soooooooooo expensive. Even after insurance it is looking to be $400 each time she does it. Once we get past the initial start up and it is $400 every 8 weeks it won't be so bad I guess, but HUMIRA seems like a option that has been overlooked.

Thoughts are greatly appreciated

princesscolon
Veteran Member


Date Joined Apr 2006
Total Posts : 733
   Posted 6/13/2008 10:52 PM (GMT -6)   
Hi, I took Remicade for about 3 years then had an increased doseage and then a reaction, now I am on Humira since April. Right now I would say I am not seeing excellent results on Humira, just decent results... but then again, I didn't see very good results on Remicade till after a year on it. I need another scope to see what's going on in there. The doctor is probably recommending Remicade since it is approved for UC now, Humira is approved for Crohn's but not UC yet. Without insurance, Humira is $1600 for 2 shots... so if your insurance does not approve Humira, the first dose would be $3200, second dose would be $1600 and after that it would be $800 every 15 days. Why is the Remicade going to be so much with insurance? I used to pay just $20 per infusion for it. I hope that whatever your wife decides works well for her.
Diagnosed with Left-sided UC in 1995 at age 15, Prednisone, Rowasa & Hydrocort. Enemas, Proctofoam, Sulfasalazine, Asacol, Probiotics, Fish Oil, Aloe Juice, Canasa, Enotcort, Colazol, Anamantle, Remicade, etc... had 1 inch deep rectal ulcer 2004, put on Remicade, August 2007:Increased Remicade dosage-700mg every 6 weeks,diagnosed w/ Psoriatic Arthritis & Fibromyalgia Current meds: Clorazepate, Lomotil,  Tylenol pm, Lyrica started 1/17/08,  Humira started 4/4/08


jujub
Elite Member


Date Joined Mar 2003
Total Posts : 10407
   Posted 6/13/2008 10:54 PM (GMT -6)   
I'm not on Humira, but I am on Remicade. I've seen articles on the web in the past that the annual cost for Humira and Remicade are similar, but with Humira you don't have the added charges of the infusion. Of course, your insurance may look at the procedures differently when it comes to co-pays, too. Because mine is given in the doctor's infusion center, it's treated as an office visit and I have a $35 copay.
Some insurers won't cover Humira at all because it's not yet FDA approved for use with UC, so check with your insurance provider on that.
I know Centocor has a special program to help people through the first year of treatment and I suspect the maker of Humira has a similar program. You can find information about Centocor's program here: 
 
 
Finally, if you live in a mid-size to large city, ask the doctor about local drug trials. If your wife could get into one of these, she'd have a shot at getting medication at no cost - although she could get the placebo for at least part of the time.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Avascular necrosis in both shoulders is my "forever" gift from steroid therapy.
Colazal,  Remicade, Nature's Way Primadophilus Reuteri. In remission since April, 2006.
 
Co-Moderator UC Forum
Please remember to consult your health care provider when making health-related decisions.


uofmcamaro
Regular Member


Date Joined Jan 2008
Total Posts : 20
   Posted 6/13/2008 11:36 PM (GMT -6)   
I have no clue why the remi will be so much. At first the Dr. office said it'd be $50 for the drug and then a $35 office visit. Now they said it isn't a "normal" office visit and that we haven't met our out of pocket of 5k so it'll be $400 each time. I guess until we make 5k out of pocket. I have no clue why that is because our insurance is telling us the $50 and then the $35. I'm at a bind now of "should I trust my insurance and just send them the bill" or "what in the world should I do?"

Eva Lou
Veteran Member


Date Joined Sep 2006
Total Posts : 3442
   Posted 6/14/2008 7:34 AM (GMT -6)   
Remicade is one of those weird drugs that have strange coverages. For example, I have Harvard Pilgrim HMO. On that, Remicade is not considered part of the prescription drug benefit for my plan, it's a medical benefit. I have my infusions done at a hospital which is in my insurance network. The hospital actually bills the insurance company for a chemo infusion- apparently Remicade is billed as chemo for this particualr hospital, maybe cause they're administered the same. So, I do not pay anything for my infusions- which is EXTREMELY good! Not even a copay. However, when I first went on it, my doctors office had to submit a ton of paperwork & such to get it covered. My GI has a specific nurse in his office who does all the Remicade related work- insurance, scheduling, etc. But a couple days before my first infusion, I got a call from some patient rep. at Centocor, who told me my infusions would not be covered...??? I freaked out, I was very ill & was really psyched to be starting it. I had to make a bunch of phone calls to my insurer to clear things up- turned out the Centocor rep. was completely wrong. I would suggest you start with your insurer- speak with a supervisor & get the clear picture. Since Remicade is sort of a gray area drug, most of the insurance reps. I dealt with gave me wrong information re. coverage. You don't want to get hit with a bill for thousands! Your doctor seems sort of clueless too- don't they do this regularly, deal with insurers & Remicade? Good luck! Also- you won't get Humira at all if you haven't tried Remciade, simply cause it's not approved for UC yet.

diagnosed with UC '02
meds-
Asacol- 8 tabs/day
Remicade infusions
Imuran- 100mgs/day
Culturelle
 
 
 
 


jujub
Elite Member


Date Joined Mar 2003
Total Posts : 10407
   Posted 6/14/2008 10:20 AM (GMT -6)   
One more thought: if you haven't appealed the insurance company's decision, try that. My unbending rule with insurers is: when they deny something, I always appeal. Hopefully the GI will help you.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Avascular necrosis in both shoulders is my "forever" gift from steroid therapy.
Colazal,  Remicade, Nature's Way Primadophilus Reuteri. In remission since April, 2006.
 
Co-Moderator UC Forum
Please remember to consult your health care provider when making health-related decisions.

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