Good point Gelita - actually it’s the same bottle… 9 months later, so perhaps that’s the answer!
Worked for the tummy symptoms though (would have been mostly the Humira, but it just helped to tip me over the line), so in the end all good!
Hey Lamb, that’s far too philosophical coming from you! I hope your family stays well and the fire doesn’t destroy your blackberries
My cousin the pharmacist says that generics come in categories of A, B, or C and these define the quality of it.
If I was you I woulkd go to a Neuro Surgeon for a Consultation
Unfortunately insurance companies do have the right to deny certain drugs that need to have special authorization. Apparently they have to the right to exhaust a certain amount of cheaper forms of treatment before paying for the big guns. Its a bitter pill to swallow sort of speak when every day, week and month I am not receiving the right treatment to slow down this disease, it gets worse and more damage is being done, not just to my joints, but also there is a chance that it might have moved on to my soft tissue organs. Its very scary. What is also just as scary is that where I live in NFLD, we have a shortage of doctors and specialists. I have very little faith in my family doctor, but am stuck with him. There is no option to just fire him and get a new doctor. I am sure if I put in a letter to our Minister Of Health, I could possible get something done, but to deal with the stress of that is overwhelming and would be a timely process. It will be something that I will have to consider in the near future.
mataribot said:
Hmm that's strange. I don't think a insurance company can legally tell you what medicine to try. I started off with Enbrel, had no issues getting that approved. While I tried various others before I went on Humira, the only issues I had with it was after I received approval. My mail order pharmacy was PITA.
I still don’t think they can tell what type of drug to try. They are not a license care giver providing you care. Just my opinion, I may be wrong.
Thank yu for rmembering Tana. Of course change as you know is bad. Of course for Tana she will never get past the memory of the other time men in uniform came to the door was to tell her, her daddy wasn't coming home. We live quite a ways into the woods, and have fire breaks etc. Its mostl a precaution to keep from getting cut off from exit.
Marietta said:
Stay safe lamb & family! I hope your granddaughter with autism doesn't have too hard a time with the changes.
This is a word for word exert from the letter my insurance company sent to my rheumy with a cc copy to me.
The special authorization review to provide reimbursement for the medication Humira has been completed.
Under this process, (my insurance company's name, unsure if I can say it in this forum) authorizes reimbursement of medications requiring special authorization, provided they meet certain established criteria. By denying a request for special authorization, (insurance co name) is denying reimbursement of a product, not challenging the medical opinion of the physician or rendering a medical opinion.
Established payment criteria indicates that Humira cannot be considered for reimbursement for psoriatic arthritis unless there has been a trial of treatment of at least 3 months with 2 other DMARDS (Disease Modifying Antirheumatic Drugs). As the criteria has not been met, coverage for reimbursement of Humira cannot be considered.
If you have any questions or concerns, please contact our Customer Service Centre at (phone number)
Special Authorization Claims Unita
Mataribot, I am not disputing what you have said, I made my statement based on the information I received from my insurance company. I assumed most insurance companies worked in a similar way, its nice to know some of them and obviously the one you have, does not
mataribot said:
I still don't think they can tell what type of drug to try. They are not a license care giver providing you care. Just my opinion, I may be wrong.
Yes they do, every policy has similar language. please message the sheriff (tracy z) to ask for help in filing an appeal. Ther are ways to go around it. Also your doc should know. When an insurance company won't let you through the front door there is always a back door or open window.
My doc was able to say I "failed" MTX quite rapidly, due to severe side effects, and I couldn't take plaquenil due to eye issues. Back when biologics first came out, if I'm remembering correctly, you didn't have to fail 3 DMARDS (often standard now) before they'd cover it. If you work with your doc, and you have bad reactions to meds (or no reaction, resulting in massive flare ups), you can be "failed" from them without the whole 3 months. I am not advocating lying AT ALL, simply taking a more proactive approach. If the DMARD works, then awesome!
Easternlady said:
Established payment criteria indicates that Humira cannot be considered for reimbursement for psoriatic arthritis unless there has been a trial of treatment of at least 3 months with 2 other DMARDS (Disease Modifying Antirheumatic Drugs). As the criteria has not been met, coverage for reimbursement of Humira cannot be considered.
My body builds a tolerance to many medications really quickly. What dosage worked for me last month, may not work for me this month. We all have different chemical make-ups, so it would suggest that we all react differently to chemicals. I developed a tolerance to Prednisone and I never took it for longer than three months, so I would see no reason why you may have built a tolerance. Be clear about what's going on with you to your doctor and good luck!
My apologies, I was wrong. Good luck to you, and I hope you get something that helps soon.
No apologies necessary Mataribot, I am learning new things here every day that will go along way to knowing not only how to deal with my condition but also with doctors and more recently my insurance company. I sent Tracy Z a message as was suggest by tntlamb and I feel empowered that I am taking control. Marietta, I was only on MTX for 3 weeks and the s/e were severe enough that my rheumy took me off it, a few months later I started on Plaquenil. My rheumy never intended it to be a long term drug for me, just something to satisfy the insurance criteria (kind of like finding that open window) lol.
Lamb, Hope you're not out of your house for too long, and that the forests around you aren't totally incinerated. It's horrible.
But they have physicians on staff that can determine eligibility according to the information your dr. tells the insurance. Many times drs. need to rewrite the insurance companies about the subject. They also many times write: MEDICALLY NECESSARY.
mataribot said:
I still don't think they can tell what type of drug to try. They are not a license care giver providing you care. Just my opinion, I may be wrong.