Prior authorization question

mine is usually the next day.

Thanks, Countess. I can't do anything until insurance gives authorization that I can get Humira and that can't begin to happen until my doc submits the request to insurance. Once insurance gives the authorization I can work with the pharmacy etc.

Question about the delivery of the drugs -- no one is at home during the day and I wouldn't want this to sit by my door all day. Do they deliver on a Saturday or can they deliver to a retail pharmacy where I can pick it up?

Is Remicade working for you?

geezer ... my PCP does does fast submissions, but I have been having issues with my GI and this time is really upsetting me. I have no idea why they are dragging their feet on this. Will have to call them again tomorrow to see what is going on.

Have you tried Remicade? Most people start with an Anti-tnf biological before Entivio.

I did not like my experience on Humira, I seemed to get all of Humira’s common side effects — I had really bad dry mouth and was itchy all the time. Remicade was great for me, I felt like my pre-UC self when I was on it.

Call and ask insurance and also the doctors office. Make sure the knuckleheads are doing their jobs, there's no roadblocks to the process, etc.

Hey CC

It was not BCBS that my doctor's team had to call.. it was express scripts and then they got approval through the pharmacy part of Blue Cross. It was not a medical determination so I kept calling Blue Cross and they didn't know anything about it- then I called Express scripts who handles my prescriptions and they get the auth approved or denied. I had to push the doctor's office person to make sure they sent the approval to the right company Remicade was handled by my insurance- not express scripts so it was different. Yes I am doing well on Remicade now... had to up my dose a little but it helped. I don't want to send you bad vibes for Humira because it's worth a try. I did get weird side effects from it but have a friend who is doing well on it. As for the delivery- be careful about the weather.. One time I forgot it got delivered and it sat outside for hours in the freezing cold- they made me discard it and they sent me new pens. They said the cold could effect the drug. also it comes with a special card inside to see if drug gets too hot - if the card has a pink dot then it has to be discarded. They usually deliver in the afternoon so a few hours will be fine as it comes with ice packs etc. The drug itself is good for 2 weeks outside of the fridge. I have an unopened box in my fridge- I wish I could give it to you.

Yeah, I figured something like that was going on. Shouldn't have to play middleman, but sometimes it is necessary to get what you need.

Once you've been officially approved for humira, then switching insurance companies is no big deal, it's quick and easy to get another pre-auth for the same med. I've been on remicade since 2012 and switched health insurance policies 6 or more times since then. No hickups/issues/etc.

Keith ... I am set on starting Humira so it doesn't matter what GI I use. I think different GIs have their own agendas with which meds they prescribe for whatever reason. I do a lot of research on all the meds so I feel pretty good about my decision. My old GI who I really liked (he retired) had wanted me to go on Humira as my first biologic, but that was before Entyvio was available and my PCP thinks it's a good choice too.. I have to give my veins a break from infusions. I've been told I have very small veins and the last straw was being in the hospital and having to get 3 different IV sites in order to get through the blood transfusions. I have an Entyvio infusion on Sat and hopefully that is the last trauma to my veins for a very very long time.

Further delays in getting the prior authorization. Found out from my benefits admin that the doc had to use a special form to send the request to insurance. Called the doc yesterday and found out that they don't actually submit directly to insurance. They use a 3rd party service who submits to insurance. I was shocked! Shuldn't they tell patients that they do that? I don't believe they did that with Entyvio. Or maybe they did and I just never knew. Anyway, I got the correct form to the doc yesterday and they said they sent it to the 3rd party. I got the number of the 3rd party so I will followup today to find out if they got it submitted to insurance. This is just crazy.

I did call the new GI yesterday on the off chance I could get in quickly and to see how they handle PAs. They do their own PAs, but he didn't have any appt for 3 weeks and I am hoping that I get approval before then, They did say they would call if they had any cancellations just in case. I told them once this was settled I would be making the switch.

~fingers crossed I get approval soon~

Insurance got the request from the 3rd party. They actually got 2 requests -- one marked urgent and one not. No idea why. Found out the 3rd party is a specialty pharmacy, but not the specialty pharmacy my insurance uses. GI's office said that's who they use now for all PAs. The name is Diplomat Specialty Pharmacy. I have my benefits admin here at work checking into all of this for me (we self-insure). It's making my head spin. I don't know if insurance will approve a different pharmacy than they use unless they approve it as out of network where I would be stuck with the bill (higher deductible for out of network).

At least there is partial progress now -- insurance has the request!

geezer -- I agree that all this stress can't possible be doing this flare any good.

Congrats! It really should not be that hard, but unfortunately, I've read so many cases where it is...