Approval and cost of Humira
My 19 yr. old daughter was just diagnosed with erosive rheaumatoid arthritis. Her Pediatric Rheumatologist wants to start her on Humira. What are the chances of our BC/BS to approve this drug. I checked with our pharmacy and they said it costs approximately $1300 a month - Yikes!
Believe it or not, the biologics can prevent further damage, and if your daughter already has damage, they have reason to approve it without making her go through other meds first. OR - they could insist that she try methotrexate or some such DMARD first. It will depend on the insurance. I had wrist damage within weeks, before being diagnosed, and as it turned out, my high liver enzyme count meant I couldn't go on MTX or other DMARDS, so my doctor put me directly on Remicade (even more expensive than Humira, believe it or not!). I ended up switching to Enbrel because I didn't like the Remicade.
I have Excellus BCBS (plus coverage through my husband in his plan) and they cover all but a $30 copay each month. My husband's BCBS by itself would have covered 80% but that would leave still a hefty co-pay!
I hope your daughter can start Humira ASAP and not have delay!
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Ellen
Thursday, October 08, 2009 at 01:04 PM
I can appreciate that, though my problems started in middle age - I have been going to a podiatrist for 10 years+. My damaged wrist is full of bone cysts. Sometimes younger people get them, and they treat them to drain and stimulate to form new or better bone. Like you say - who would have known?
God for you for taking the initiative!
andrew
Saturday, October 10, 2009 at 01:53 PM
My BCBS system approved Enbrel and now Cimzia, two biological drugs similar to Humira rather quickly. But this was after I failed methotrexate. And the copays were minimal. Your daughter should start some sort of treatment asap.
http://livingwithra.wordpress.com
If you have problems getting coverage, there are a number of other options available for you. Lisa Emrich, one of our experts, recently wrote a post about options for funding for medication and you can read that here.
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She has had bad damage to her 5th metatarsils in both feet. If we only knew! She was an athlete and played sports 24/7 so we just thought her foot issues were from wearing tight cleats, etc. We were taking her to a Podiatrist for over 2 years and he told her she had Taylor bunions with bilateral bone cycts which he treated with orthodics and recommended surgery if the orthodics didn't work. Thankfully, I had enough mind to take her to a foot orthopedic surgeon this summer and then we were eventually referred to a Rheumy.