Wow, I am really REALLY having a hard time with my health insurance and Humira. Any insight would be helpful..here is the rundown:
United Healthcare stopped honoring the Humira co-pay assistance plan. It shot my $5 a month copay up to $200 a month. I got hooked up with a Humira representative..who made arrangements for my prescription to come from a different pharmacy. My copay disappeared entirely. It was a miracle!
It was time for a refill, and I get a call back from the pharmacy. My health insurance is requiring me to go to the original pharmacy that was charging $200 a month. It boils down to this: pay $200 copay, or don't get Humira AT ALL. They will NOT let me get it from any other source.
My doctor's office is calling Humira for help..but we may have to consider alternatives. At this point, I am having a flare..and I am starting a round of Prednisone to get me through.
If I cannot continue on Humira, my doctor said most other biologics would be an issue as well due to their high cost. I suggested Remicade IV treatment as it was 'an office procedure'. He said it would be a travesty if I had to go that route..and that there were a lot of horrible things that could happen with that type of treatment.
Is anyone on Remicade? He mentioned sometimes people develop allergic reactions, IV fusion issues..and who knows what else.
Does anyone know what the heck I should consider if I can't afford the copays for a biologic and if my doctor is anti-Remicade?
I do currently take methotrexate, naproxen, folic acid, fish oil, vitamin D, and tramadol as needed for pain.
I appreciate the help! It is so frustrating to have found a solution and the corruption of insurance makes it impossible to get the treatment you need!!!!!
UH still accepts Co Pay assistance cards for other biologics. Also, AL offers refunds for all there valid cards. You need to call them and ask about it and the procedures. …
I am sorry you are going through this struggle. My insurance recently switched me to a mail order specialty pharmacy. It got screwed up and the prescription was bounced between two branches of the same parent company for almost two week before that cancelled the refill altogether. I spent every day on the phone talking to customer service people at the different pharmacies only to get a different explanation each time. I know what you have been told. But my experience is that it took repeated calls to finally get things on track. So do not lose faith. There must be a way. I did a quick search.
The National Psoriasis Foundation confirms your experience, namely that UH has stopped accepting the copay card.
The foundation says that "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)."
Also, you may want to go to the link I provided and register your experience with the national psoriasis foundation. They want to hear from you. Good Luck!
Dandylyons, we must use the same specialty pharmacy. The pharmacy itself is OK, but their "customer service" people screwed things up beyond belief. They actually PAY people to call and tell me that the prescription that had to be sent a certain day wouldn't be, that they could sure get that out for me in the next week or two, and shipping (on a frigging biologic) would take three days. All the while, the pharmacy people had it ready to go, next-day shipping, on the appointed day.
Ella, run for Congress. Lots of vacation time, free health coverage with no co-pays, quite the deal.
The run and around you are getting does not happen with all biologics. Abbott Labs is a stickler on charging full retail price on Humira to third party pharmacies. I had absolutely no problem getting Stelara approved, but Humira was an absolute nightmare. That information came directly from my dermatologist.
I find this scary and disturbing. I have pre-approval for Enbril but all of the biologics thru Express-Scripts AKA Medco are &200 co-pay. The customer wervice rep assured me that this was for 3 mos but I am beginning to wonder. I can go to a retail pharmacy but it will be 300. I'm in the mid-range of co-pay for the year and catastrophic coverage is still the same $$.
What next? I have a new Rheumy whom I have seen only once so far. Switched as the previous one wanted to start Enbril without any base-line bld work. PsA was just a guess and Mtx had no effect on the pain.
Did you get any traction with the new reimbursement process at the Humira helpline as is described by the National Psoriasis Foundation? If Humira is working for you, you should certainly fight to keep it. The issue with other biologics is that they may or may not work for you. Each of us is different. A further search showed that several forums where patients are on Humira and have UH insurance have the same experience as you. It seems that UH & Abbott are feuding. So hopefully the Humira helpline can guide you through the reimbursement process. Hang in there!
Run for congress - lol! thanks for the laugh... sadly that probably IS one of the few ways to get good coverage.
Louise said:
Dandylyons, we must use the same specialty pharmacy. The pharmacy itself is OK, but their "customer service" people screwed things up beyond belief. They actually PAY people to call and tell me that the prescription that had to be sent a certain day wouldn't be, that they could sure get that out for me in the next week or two, and shipping (on a frigging biologic) would take three days. All the while, the pharmacy people had it ready to go, next-day shipping, on the appointed day.
Ella, run for Congress. Lots of vacation time, free health coverage with no co-pays, quite the deal.
I had the same issue as you did with Humira. As I said before, you can get reimbursement for your copay with valid card. Finding a biologic that works and your body does not reject had caused many of us headaches. I would fight for your Humira, before trying something else.
I went thought the same thing with UHC. I got a new rx from my doc and took it to CVS pharmacy. Got it filled that day, with my copay card and paid $20.00. He history is that UHC told me I HAD to go through their specialty pharmacy to get my drug covered. That wasn’t true. It’s worth a shot.