I hate to admit this when others are suffering, but I am quite happily 'stable' and have found a treatment that works for my Psoriatic Arthritis and Fibromyalgia: Humira. I do take a mixture of other drugs, such as methotrexate, but I accredit Humira as the biggest influence on my improvement.
Here comes the 'UH OH' moment…I called my specialty pharmacy to refill my Humira. Unfortunately, my insurance no longer is accepting their Co-Pay Assistance program. My copay has gone from $5 a month to $175 a month. Although Humira is my saving grace, I absolutely cannot afford an additional $200 bill a month!!!
Do you guys know what other options I have? Are there other medications similar to Humira that work just as well? If so, what are your experiences with them? How do you take them (injection, IV, etc).
I am feeling a little lost..I know my Rheumy will help, but I have an entire weekend to squirm uncomfortably until I can speak with him. I would appreciate ANY insight!!!
As Robert said, Enbrel is an option, but I think you will run into the same insurance issue. Remicade is administered in the Doctor's office so it will likely fall under your medical benefits rather than pharmacy benefits. It may be better or worse.
Also, call Humira. See if they can reimburse you the $170 difference. See there's a bit of a game going on between the insurance companies and the drug companies. The insurance companies want to give you strong incentives to find cheaper meds, so they put high copays on drugs such as Humira. The drug companies combat this through their financial help programs. So your insurance company fought back and said that the pharmacy can't accept money from Humira. But Abbot Labs still wants you buying Humira. Maybe they can and will give you the benefit after the fact. You will likely have to send in receipts.
UnitedHealthcare is changing their policy on Humira copay assistance cards
UnitedHealthcare's Specialty Pharmacy network will no longer accept copay assistance coupons or cards as payment for Humira beginning January 1, 2013. This new policy is not a denial of coverage for Humira—Humira is still covered—however you may see an increase in your copay at the pharmacy counter.
What you can do
Copay assistance is still available after purchase of Humira by applying for copay reimbursement through the myHUMIRA protection plan. For more information on this new reimbursement process, please contact a myHUMIRA reimbursement counselor at 1.800.4.HUMIRA (1.800.448.6472).
You know, something interesting happened to me when I was on humira. I had been ordering mine from United healthcare’s specialty pharmacy for about a year. When I went to the derm for follow up, he sent my Rx to CVS by mistake. CVS filled it, and I went to straighten things out for them to transfer the Rx back to the specialty pharmacy. When I went, I asked what the copay would have been, and I was told $50. This is the EXACT SAME copay I had with the specialty pharmacy, only it wasn’t such a pain in the a to get my meds filled. I kept the script there, got a new Rx assistance card (Prescription Solutions wouldn’t honor it) and stayed with CVS.
UnitedHealthcare's Specialty Pharmacy network will no longer accept copay assistance coupons or cards as payment for Humira beginning January 1, 2013. This new policy is not a denial of coverage for Humira—Humira is still covered
Copay assistance is still available after purchase of Humira by applying for copay reimbursement through the myHUMIRA protection plan. For more information on this new reimbursement process, please contact a myHUMIRA reimbursement counselor at 1.800.4.HUMIRA (1.800.448.6472).