Humira approval advice?

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Peety
Veteran Member


Date Joined Mar 2008
Total Posts : 2855
   Posted 4/2/2009 9:43 AM (GMT -6)   
I've been waiting now for more than three weeks to get Humira approved. I knew it might not be easy, since under our Rx insurance (Caremark) it is a "specialty pharmaceutical" that requires review and, of course, Hurmira is not approved yet for UC. I'm told that since I did not meet the Humira guidelines, it is going through a review process involving BCBS. I'm told there is nothing more I can do to expedite it, and I think the case manager is sincere in her efforts and we talk almost every day.
 
Any advice, or insight about how long I should let this drag on before I just do Remicade instead? For many reasons I would prefer Humira, not the least of which is that it is a less costly approach to treatment even if it costs ME more (I care about controlling health care costs in this country generally). 
 
Should I do a Remicade infusion to get the ball rolling, then switch to Humira? I know I can ask my doctor, but it's on my mind right now and I wonder if anyone knows. This flare has been particularly draining on me and I'm eager to do something aggressive this time.
 
Appreciate any advice!
 
49 year old female attorney, diagnosed UC/pancolitis 1985, no surgery but much suffering. Asacol/5ASA 6x400 mg maintenance for 20+ years; use prednisone & Rowasa for flares. 
August 2008 sought care of naturopathic doctor. Food sensitivity test showed wheat/gluten, other intolerances; eliminated all wheat/gluten from my diet. Probiotics (Ultimate Flora, 50 billion), trying Curamin. 
Flaring, seasonal? or supplements too harsh? Back on prednisone, tried to taper but now back up to 20-30 after several really bad days. Waiting for insurance decison on Humira...soon... 


fruitgirl
Veteran Member


Date Joined Feb 2009
Total Posts : 7150
   Posted 4/2/2009 10:49 AM (GMT -6)   
Gah, Peety, how frustrating this must be! I don't know what to tell you, really. Was the case manager able to give you any sort estimate as to when there would be a decision? It sounds like you are really getting exhausted, though, so if I were you, I'd probably think about doing a Remi infusion just to see if you start to feel better.
Symptoms began in November 2008, ~4 weeks after giving birth to my son.
Eased for ~3 weeks in December, possibly b/c of probiotic use?
Returned in January 2009 (with a vengeance), diagnosed with pancolitis on January 30.
Currently taking Asacol (400mg 4 pills 3x daily), Rowasa nightly, 40mg 30mg 20mg 15mg of Prednisone (quick taper), Culturelle probiotic, and Zoloft (25 mg).


Peety
Veteran Member


Date Joined Mar 2008
Total Posts : 2855
   Posted 4/3/2009 10:17 AM (GMT -6)   
Humira was denied, no suprise I guess. I wish they would get that approved for UC! I'm sure I make too much to qualify for any of the drug company's programs.

So I am going on Remicade, as soon as that gets OK'd. Oh well, doc says she finds it works a little better anyway.
And with this bad flare she told me to take 40 mg prednisone, for a day (?), then 30 for the time being. Here comes the fuzzy moon face...bummer.
49 year old female attorney, diagnosed UC/pancolitis 1985, no surgery but much suffering. Asacol/5ASA 6x400 mg maintenance for 20+ years; use prednisone & Rowasa for flares. 
August 2008 sought care of naturopathic doctor. Food sensitivity test showed wheat/gluten, other intolerances; eliminated all wheat/gluten from my diet. Probiotics (Ultimate Flora, 50 billion), trying Curamin. 
Flaring, seasonal? or supplements too harsh? Back on prednisone, tried to taper but now back up to 20-30 after several really bad days. Waiting for insurance decison on Humira...soon... 


fruitgirl
Veteran Member


Date Joined Feb 2009
Total Posts : 7150
   Posted 4/3/2009 10:21 AM (GMT -6)   
Crap, Peety, that sucks. I know you really wanted to do Humira so that you didn't have to deal with going to the infusion center. How soon do you anticipate being able to start on Remicade? I hope it's soon and that it's your "miracle" drug!
Symptoms began in November 2008, ~4 weeks after giving birth to my son.
Eased for ~3 weeks in December, possibly b/c of probiotic use?
Returned in January 2009 (with a vengeance), diagnosed with pancolitis on January 30.
Currently taking Asacol (400mg 4 pills 3x daily), Rowasa nightly, 40mg 30mg 20mg 15mg of Prednisone (quick taper), Culturelle probiotic, and Zoloft (25 mg).


hana24
Regular Member


Date Joined Dec 2007
Total Posts : 354
   Posted 4/3/2009 2:21 PM (GMT -6)   
My doctor says that Remicade has a much higher success rate than humaria anyway. It isn't working for me so I am going to try Humaria my doctor said he can get it for me "off label"? Im not sure what that means.
Jessica 27/F
Remicade
Lialda 4.8GM
Citalopram 20 MG


jujub
Forum Moderator


Date Joined Mar 2003
Total Posts : 10407
   Posted 4/3/2009 5:45 PM (GMT -6)   
I'm hearing from my GI that Humira might be approved for UC as early as this fall.

Hana, "off label" simply means the doctor is prescribing it for something it isn't officially approved for by the FDA. Like Humira for UC. Doctors can always prescribe this way, whether your insurance will cover it is a different issue. Peety's request was reviewed and denied. My health policy clearly says off-label drugs are not covered, so they wouldn't even review it. This was why I had to wait for Remicade even though I was horridly sick.

On the other hand, in some countries you can't get drugs like Humira or Remicade at all except for a short course. They simply aren't available for maintenance. I guess there's no perfect system.
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.
"My life is an ongoing medical adventure"
 
Co-Moderator UC Forum
Please remember to consult your health care provider when making health-related decisions.

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