Humira & Ins. coverage

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Eva Lou
Veteran Member


Date Joined Sep 2006
Total Posts : 3442
   Posted 10/8/2008 10:28 AM (GMT -6)   
hi everyone- there have been quite a few posts on Humira the past couple days. As it may be my next "latest & greatest" drug, can anyone clarify insurance info on this for me? I do know it is not currently approved for UC. My GI has told me that if you can prove that no other drugs work for your UC, your insurance will cover it. Obviously, you'd have to have tried Remicade first. And from the people on here who have taken it, some are covered in full, some aren't covered at all. What gives? For those of you who do get your injections covered by your insurance company, how did you do it? Did you need to prove to them that you were refractive to all other UC meds? How does your insurer cover a non-approved drug? And for those of you who don't have coverage for the injections, is it simply because the drug is non-approved for UC? Despite what your doctors are telling these companies, they still won't allow it to be covered? I'm confused- it seems so random, insurance coverage for this....
diagnosed with UC '02
meds-
Asacol- 8 tabs/day
Remicade-10mgs/kg- since 4/07
Imuran- 150mgs/day
Culturelle
Fiber supplement
 
 
 


Sunshineonmyface~
Regular Member


Date Joined Sep 2008
Total Posts : 202
   Posted 10/8/2008 12:24 PM (GMT -6)   
There is a post about a gal who is getting humira for free through a trial, check into that. I don't know how to post a link. It really is confusing!

heathd
Regular Member


Date Joined Sep 2008
Total Posts : 40
   Posted 10/8/2008 1:47 PM (GMT -6)   
http://www.needymeds.org/

the link for Patient Assistance Program. I currently have Advantage Insurance and they would not cover the humira regardless that it was the last drug i had to try to get my UC under control. I had my doctor as well as the director of the hopsital i stayed at both send in appeals to my insurance and they would not cover it. i was on remicade for a little over 2 years before my body built up a tolerance for it and it started to not work. In the end with remicade it would work for the first cpl days after the infusion than i started into a flareup within a week. It started every 8 weeks than i progressivly started to start a flare before the next infusion and the time between infusions started to get shorter and shorter until it quiet working for me. I start Humira next week and am hopeful that it will work. i hope the link is what you was looking for. The place is very helpful and they try to help you as much as they can.

jujub
Forum Moderator


Date Joined Mar 2003
Total Posts : 10407
   Posted 10/8/2008 2:00 PM (GMT -6)   
It totally depends on your insurance coverage; your customer services rep could probably tell you. In my case, my policy specifically excludes coverage of any treatment that is not FDA-approved. Before Remicade was approved, there was no way they would pay for it.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Avascular necrosis in both shoulders is my "forever" gift from Entocort.
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.


Eva Lou
Veteran Member


Date Joined Sep 2006
Total Posts : 3442
   Posted 10/8/2008 2:34 PM (GMT -6)   
mine is the same way, Judilyn- no coverage for unapproved meds. BUT...my GI claims they will cover it with all the hoops successfully jumped thru! I guess that means the doctors have to write a million reason letter why they feel you should be on it. And even then, I guess it would depend on the coverage. He claims the Humira rep told him that- which could mean anything, as they are just looking to make money. But for those who are getting it covered, does your policy state that unapproved drugs will be covered under certain circumstances? If so, that's some pretty good coverage! I know about the patient assistance programs, but I'm mainly referring to insurance coverage. I've never had, or heard of, an insurer who states in a policy that they will in fact cover an unapproved drug- I guess there are some who will????
PS- I just added needymeds.org to my favorites!


diagnosed with UC '02
meds-
Asacol- 8 tabs/day
Remicade-10mgs/kg- since 4/07
Imuran- 150mgs/day
Culturelle
Fiber supplement
 
 
 


Pibbin
Regular Member


Date Joined Apr 2008
Total Posts : 163
   Posted 10/8/2008 8:23 PM (GMT -6)   
Eva Lou,

If your insurance won't cover the Humira, try contacting Humira's Patient Assistance Program. They will give you advice on how to get it approved, and may provide free meds if you are denied.

Granted, I have Crohn's-colitis, but I was given 3 months of free weekly shots, after my insurance denied my specialist's recommendation that my dosage be increased from once every two weeks to weekly. And I was approved for a year's worth free, they just send it quarterly. Unfortunately, Humira stopped working for me. But while it did, I came closer to remission than I ever had before, I felt great.

Abbott seems very motivated to get Humira out to consumers for these diagnoses, so check it out. You can start with the web site, I think it is myhumira.com.
Dx Mild Proctitis 7/06 at age 33, Dx Severe Pan Colitis 5/07, Dx Crohn's Colitis 10/07
Failed Asacol, Lialda, 6-MP, Canasa, Rowasa, Entocort, and Remicade, weekly Humira
Late 7/08, down to 5 mg pred, and big flare, Humira failed
2 week hospitalization in 8/08
Now on Pred 25 mg, cyclosporine, percocet, xanax
Surgery scheduled 10/10/08 to get rid of this colon

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