Humira fight with insurance

Avatar for donnaldy59
iVillage Member
Registered: 11-19-2001
Humira fight with insurance
15
Tue, 05-17-2005 - 8:19am
My insurance won't pay for Humira and I'm getting the run-around.

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iVillage Member
Registered: 11-03-2003
Tue, 05-17-2005 - 1:26pm
((((((((((( Donna ))))))))))), I do wish you a lot of luck with the group administrator.

Molly

Avatar for donnaldy59
iVillage Member
Registered: 11-19-2001
Tue, 05-17-2005 - 10:02pm
Oh jeesh Molly it just keeps getting worse!
iVillage Member
Registered: 05-19-2003
Wed, 05-18-2005 - 1:22am

Oh Donna!!

I feel your pain!!! I went through this insurance mess last year when I was switching insurances at a new job. I had a choice of about 5 plans from 3 differenct providers. Well, I thought I would be proactive and call to see which one would cover Humira and it just wasn't as easy as it should be. First of all, when you call and ask be sure the person you talk to realizes that this is not a normal Rx and that it is an injectable. That tends to make a big difference as to weather its covered as a Rx or not. I found out that my Humira is NOT covered under the Rx part of my insurance but as a procedure.

Anyhow, I know its all frustrating and confusing. Hopefully this new insurance will have better coverage for you. I ended up paying a higher premium per month but my Humira is covered 100%. Research pays off in the end. Good luck!!!

And... your rhemy will have to get Humira reapproved with your new insurance... maybe you can ask if he will say its for RA instead of your Chrons (sp?). Might have a better chance of approval.

Smiles, Jen







iVillage Member
Registered: 04-08-2004
Wed, 05-18-2005 - 11:25am

Donna, if you are going to be covered by United Healthcare, consider yourself lucky. I have been through a multitude of insurance plans, and United was by far the best. I imagine it is about the same in Arizona as in Colorado. A few years ago, they did a study on the efficacy of their department that "approved" doctor's treatment. They found that it cost them $14,000,000 to run the department, and they saved $1,000,000 by doing so. Therefore, they did away with the pre-authorization for a lot of treatments. If your doctor says you need it--that's it. They paid for my Remicade (completely) and Humira (think I had to pay $40.00 a month) with no fuss at all. I know I didn't have to do anything for Remicade approval, and the doctor was amazed that when he called for "approval," they told him it wasn't necessary. I think all I did for Humira was take the prescription to the drug store and it was filled like any other. The $40.00 was the price of brand name drugs. Also, once United finds you have a chronic condition (again, this is Colorado), they assign you to a nurse who calls, introduces herself, talks to you about your condition, and makes sure you know you can call her anytime with any questions, etc. She followed up with me about once a month to see how I was doing. And, when I started Remicade and then Humira, she called to see how it was going. I really liked her, and it sort of made you feel like a human being instead of just a number. My current plan (Mutual of Omaha) also has that service, but they leave it to you to call them after the initial contact. Hope United is as good to you as it was to me.

Rosemary

iVillage Member
Registered: 11-03-2003
Wed, 05-18-2005 - 12:59pm
Gee whiz, Donna!!

Molly

iVillage Member
Registered: 11-03-2003
Wed, 05-18-2005 - 1:02pm
That's good news about United Healthcare.

Molly

iVillage Member
Registered: 04-08-2004
Wed, 05-18-2005 - 4:17pm

I'm still around--chasing my tail at work, as usual. I have so many frequent flier miles that I could go someplace far, far away, if I had time for a vacation. I have my ouchy days and my tired days, but I'm hanging in there. Saw the doctor yesterday for the routine stuff. He took hand and feet x-rays to compare with last year's. Thankfully--no change--still no joint damage, so I guess the MTX and cyclosporine are doing their thing. I complained about the fatigue, and he informed me that completely healthy people would complain of fatigue if they kept my schedule. I think I got through to him that it wasn't "normal" fatigue--it was the sick kind of fatigue not the tired kind of fatigue. We talked a bit about his research and what was going on with the drug studies. He said he hasn't been so excited and optimistic since the studies that led to the TNF drugs began back in the early 90's. He's really high on the -- senior moment -- can't remember the name. It begins with an "R,", is the one that they have been using for lymphoma, will probably be approved for lupus later this year, and is a twice a year infusion--focuses on the type B-cell inflammation. Still can't remember, but we've talked about it here before. Anyway, he said it seemed to be working well for people who have "failed" the TNF drugs ("failed" always makes me feel like it is my fault they don't work for me). They are beginning the long term safety study for RA, and I might join in if they can work around my schedule.

It is spring-time in the Rockies--90 one day and close to freezing the next. Supposed to get up close to 90 by Friday. I've been spending a lot of time commuting to Portland, and (no offense to people in Oregon who I have found to be delightful) I'll take Colorado sunshine anytime.

My little guys have settled into their new home quite well. It was quite an adjustment to go from one elderly cat to three young ones. Jack is the ring-leader. He has to see what everything is, how it works, if it is "playable," etc. Bobby follows Jack around and enthusiastically joins in any "games." Teddy trails along behind, very watchful and muttering, "We're going to get into trouble, guys." It's a good thing we have a king-size bed, and even then, it gets sort of crowded at night. Bobby and Teddy will be a year old June 1, and the vet thought Jack was about the same age so put his birthdate down as the 1st in his file. That way, we only need to have one party! Somehow, I don't think party hats would last very long around them.

I'll be around a little more the next couple of weeks. Talk to you soon.

Rosemary

iVillage Member
Registered: 11-03-2003
Thu, 05-19-2005 - 2:12pm

Rosemary, thanks for the update.

Molly

iVillage Member
Registered: 04-08-2004
Thu, 05-19-2005 - 5:17pm

Yep, Rituxin it is. According to the doctor, it is doing really well in the RA trials. It has been approved for some kinds of lymphomas, and he thinks it will probably be approved for lupus later this year. RA approval is still a ways off though. He is involved in the RA trials, so it is a possibility for me. Also, they called me about another trial, and I posted another message to put your sleuthing abilities to good use. Apparently it is also doing well in trials, and even though it is a TNF inhibitor, people who have not responded to other TNF drugs are responding to this. I sort of like the idea of it better because it is injections instead of infusions (less time spent in the doctor's office) and because it lasts for 18 months. So, if I responded well to it, I would be set with the medication, labs, and doctor's visits paid for 18 months. I would have to stop the cyclosporine but could continue with the MTX. I'm thinking about it.

Rosemary

Avatar for donnaldy59
iVillage Member
Registered: 11-19-2001
Thu, 05-19-2005 - 10:41pm

Thanks Jen!

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