Hi,
I just need to vent a little here. I've been on Humira thru a clinical trial study from November 2003 to March of 2006. The Humira has worked very well for me for my pa and when I started the study, I had over 98 joints affected with pa. Now I'm down to 36 joint affected. It's come down alot.
Since the study is over, my Doctor has put in a request for Humira for me from my insurance company. I've been denied as of over a month ago. It's now trying to be appealed. My insurance company is an HMO here and called "Prefered Care". I've been hearing alot of people have been having problems with this company.
Sure hope they come around and approve my being treated for pa with Humira. Humira was approved on October 4th 2005 for treatment for pa. It was approved while I was still helping with the clinical trial-----and now I'm not suppose to get approval for it? Doesn't make much sense.
I also heard today that everyone that was in this clinical trial study here has been approved for Humira with their individual insurance companies, except me (just one person not approved----me!) Must be everyone had a different insurance plan.
Thanks for listening---sorry this is so long.
Sandy

Did they give a reason?? Was the clinical trial part of it? Surely they can't just say NO and not give you any recourse...
I don't know much about insurance, I have it, and so far, so good; I'll be up for renewal in September though and I started Humira in February. We'll see. Please let us know and I'm sure somebody who knows more than I can help.
patti

That is absolutely ridiculous!!! I would appeal it until they get sick of hearing from you!!

Hi Sandy,
I am so sorry to hear about this, but I have a feeling that you can overturn it. It is so blantantly unjust! I would make absolutely sure, when you contact your HMO, that they know they are the only company that did not approve Humira. I would also call the company that makes Humira and make sure they know, and I would ask your doctor to write a letter to the company. Surely this can be overturned! I know it is just another hassle and I surely sympathize. We all get so tired of jumping through hoops (so to speak)! Keep at 'em and let us know how it unfolds! Good luck!
Take care,
MK

I agree MK...it almost seems like a legal matter if they don't pay for it. I am not sure about that...but they have to give her some options....and if her doctor said this is the drug she must take...seems like they would have to go with what the doc recommends.

Hi Sandy,
I'm so sorry. Have you gotten in touch with the NPF? They have an insurance advocacy service that will try to help you with your appeal. Here's a link to their description of their service: and here's a link to their contact information: .
Also, I know that the Enbrel's customer assistance service tries to help people who are having insurance issues. I can't tell from Humira's website (www.humira.com) if they off a similar service, but you also might want to get in touch with them.
I hope this helps.
Good luck.
Keep us posted.
Mike

I also had problems getting Humira -- it took the rheumy's office almost 3 weeks to get it approved. I will take my first injection sometime this week. I'm really looking forward to it -- I need relief!

Sandy,
I can't believe that you, of all people, could be denied this drug that has worked so miraculously for you! :( :mad: I know that I am also in the 2 year study for a couple more months, but I was told by the study clinic that Abbott was extending the study beyond 2 years for longer term follow up. Is there any possibility you could qualify for the same thing? I know what a fighter you are, and I know you won't give up easily, so I would suggest starting with either your study doc or directly with Abbott. I certainly hope that amongst them they can find a way for you to keep getting the Humira that has helped you so much. You're practically one of their poster children! I'll certainly be pulling for you, and I'm just a phone call or an email away if you need someone to rant or cry to.
xoxo

Sandy,
Keep up the good fight Sandy, don't give up or in!
xo,
Karen

Thanks everyone for listening and giving me good advise on how to handle this. I've been worrying about whether my insurance company would approve me for this and when I was denied, I was upset. The Doctors are now handling the appeal, but I think I will call the insurance company myself and also get in contact with NPF advocacy.
Right now the head of the clinical trial studies has been able to keep me supplied for short time with Humira so I won't have to completely go off it right now-------but again we need to get approval from ins company.
Thanks to all with very good ideas and thoughts.
Sandy

You keep us posted! I am sure everyone is on board for going to bat for you. And they don't want all of us on their bad side!!! Right?!!!

Sandy, Is your Insurance Blue Cross? I had a run in with them myself. Call them yourself even if your Doctors are handling it. I called them every 2 days for a while. It worked. Linda

Just an updte.
As of April 30th I've been denied the second time for Humira. I just got off the phone with Preferred Care and discussed the denial and have written to the NPF insurance advocacy to offer assistance in help with this insurance company for approval.
Really stress out here in Rochester!
Sandy

hi sandy,
sorry to here that. i hope you get your med. i wish you the best my friend
have a good week end all
richard

Hi Sandy, I just got approved this week hor humira! It has taken several monthes. Both my derm and my rhem drs. got together and pushed the insurance company. The other derm I saw didn't want to even bother trying to get it for me ,said it would be turned down. She just didn't want to invest the time I think. Do you have a rhem and a derm? See if they will try together to get it for you. Good luck and keep bothering the insurance company! Lynne

Thanks everyone! I also head from Alyssa Brown at NPF advocacy for insurance and she will be getting back to me either today or Monday at the latest about this.
I do have both a derm and rheummy and the Rheumatologist and the head of the Clinical Trial studies have already been going to bat for me. I will keep on finding out what to do.
I am glad I have all of you to talk this over with. I was pretty upset this afternoon.
Thanks again and I'll keep you all posted.
Sandy

Sandy,
I recommend a nice glass of red wine for you to help with the stress!
I'm so sorry that the battle continues but the war isn't over...I know you and your good drs will keep up the fight!
Hang in there!
xo
karen

I think that's deplorable on the part of your insurance Sandy. I hope your doctors let them have it with both guns fully loaded.

Keep trying! Insurance is such a big part of our lives when you have this disease. Good luck!
Nancy

Great job following up! I think a lot of insurance companies just hope we will go away with a quick denial.
Good Luck! Keeping you in my thoughts.

Thanks!
I'm anxious to see what will happen next. Come Monday, I'll be calling my Doctors to let them know of the next route I'm going.
What I don't understand is our insurance just went up over 150.00 over the past year and a half (over 150-per month) and unfortunalty my husband is on SSI and early medical retirement and we pay for my insurance at the full price. Then the newspaper just can out and said how much the president of the local insurance company makes per year, and "oh my goodness----it's so much!!!"
I'll keep trying. Thanks,
Sandy

Hi,
Over the weekend I filled out a grievance form and submitted it to Preferred Care. I make copies and sent one to my Doctor and head of the clinical trial and also to Aylssa Brown for the foundation here who has offered to help me along the way.
Now I'll see what the next step is
Sandy

Sandy,
Have you been in touch with Abbott Immunology? Their patient assistance department might be able to help you.
Liz