Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
For a brief recap to start -
At my last appointment in November, since I had new insurance I had the doc write an Rx for Humira - I had been receiving it for free thanks to the Abvie Foundation prior.
Received a denial letter which said that I had to try Enbrel first. After 2 phone calls and a letter directly to the doc I had no response at all about the denial letter and about getting a pre-authoriztion for Enbrel. I had taken my last injection of Humira in the middle of December and have been going downhill since. To say I was upset about all this is being nice......
Doc came in and the first thing he asked is why I wasn't still taking Humira. So I told him the story, and he became flustered for a lack of a better term. He had not received my letter (never made it from the office to him) and said there was no excuse for the office staff to not return my phone calls. That being said, he was more upset about how the insurance companies try to dictate what he does. This doc is one of the heads of a huge arthritis research center. As I have seen in the past he is so focused on the science of the disease he doesn't realize what happens in the office. His point was that the Humira was working for me and should not have to change just because an insurance company says so.
Instead of dwelling on what happened, he immediately wrote me an Rx for 1 year worth of Enbrel plus my other regulars of Methotrexate, Folic Acid, and Prednisone.
Well I get home and call the insurance company since I didn't know what to do with the written Rx. The rep was very nice to me, and started by looking up Enbrel to see that it was covered. Yes, it is in fact covered, but needs a pre-authorization. I told her about the denial letter about the Humira which stated that Enbrel was OK, but that didn't matter. Now....only the doctor's office can call for this pre-authorization.....oh boy....here we go again. So I take a deep breath and call. I spoke to a girl who sounded very knowledgeable about these things, and took down all the info. She asked to give her a couple days.......
Man oh man - I know I am not the only one having problems like this - I've seen quite a few posts in the past weeks with similar problems.
It isn't over 'till it's over........
At my last appointment in November, since I had new insurance I had the doc write an Rx for Humira - I had been receiving it for free thanks to the Abvie Foundation prior.
Received a denial letter which said that I had to try Enbrel first. After 2 phone calls and a letter directly to the doc I had no response at all about the denial letter and about getting a pre-authoriztion for Enbrel. I had taken my last injection of Humira in the middle of December and have been going downhill since. To say I was upset about all this is being nice......
Doc came in and the first thing he asked is why I wasn't still taking Humira. So I told him the story, and he became flustered for a lack of a better term. He had not received my letter (never made it from the office to him) and said there was no excuse for the office staff to not return my phone calls. That being said, he was more upset about how the insurance companies try to dictate what he does. This doc is one of the heads of a huge arthritis research center. As I have seen in the past he is so focused on the science of the disease he doesn't realize what happens in the office. His point was that the Humira was working for me and should not have to change just because an insurance company says so.
Instead of dwelling on what happened, he immediately wrote me an Rx for 1 year worth of Enbrel plus my other regulars of Methotrexate, Folic Acid, and Prednisone.
Well I get home and call the insurance company since I didn't know what to do with the written Rx. The rep was very nice to me, and started by looking up Enbrel to see that it was covered. Yes, it is in fact covered, but needs a pre-authorization. I told her about the denial letter about the Humira which stated that Enbrel was OK, but that didn't matter. Now....only the doctor's office can call for this pre-authorization.....oh boy....here we go again. So I take a deep breath and call. I spoke to a girl who sounded very knowledgeable about these things, and took down all the info. She asked to give her a couple days.......
Man oh man - I know I am not the only one having problems like this - I've seen quite a few posts in the past weeks with similar problems.
It isn't over 'till it's over........
Afraid it's going to get worse as insurance companies cover fewer prescriptions in order to hold down costs and maintain profit.
Hope the office lady does her job this time.
Hope the Enbrel works well for you! When you finally get it that is!
Cindy
Well wow! I would think the first thing the dr would do is ask his staff why the heck he never seen any messages or letter? Someone should answer for that.
Im not sure about RA meds but wonder if your dr wrote appeal for Humira if it would helped.
According to the nurse whom I spoke with on the hotline for Enbrel The Enbrel should not take as long as some of the other meds to work. On first injection I felt a difference, very lucky. Nothing major but better then nothing. Also felt side effects. Hoping you skip those.
Now she told me 6 wks was long enough. Maybe someone else here has some input.
If it's not working the doctor should put in for Humira ASAP.
I was told the same, couple days for pre authorization.
Enbrel has/ has co pay assistance also. I'm sure there are restrictions. Hopefully the pharmacy gives you this info.
Let's hope your dr spoke to his staff & you do not go through this again.
Wishing you the best of luck with Enbrel.
Sammy
If people would only do their jobs in the first place!
Best wishes
I didn't know what to expect with his reaction to my story. He immediately went to a solution rather than dwell on what had happened. I think it is a good possibility that this will be brought up to the office manager - I think he was trying to stay professional and not get into it too much in front of me. I will say that when I called this afternoon, the girl was very pleasant and knew exactly what she needed to do - maybe it had been brought up already.
And as a side note - at my last visit in November, I was still in the free Abvie program until this coming May. I told the doc that I didn't want to take advantage of that program and continue with the free meds and to please start the process to get it through my insurance. He was so proud of me when I said that! He said that he liked my attitude about it in that makes more available to those who really need the program like I did last year. Then look what happened......I think he was a lot more upset than he let on today.
According to the denial letter for the Humira, I have to try the Enbrel no matter what. Then if the doc feels it isn't working, he can then appeal to them about the Humira.
So much time lost. It took me 6 months back and forth with Abvie to get started on the free program, then the Humira took 4 months to start having any effect on me. It was just starting to work for me in October, then I ran out in December. I've heard that the Enbrel works for some and not for others, but the same with Humira. It seems we are all different with how these meds work. Like you say - when I go back in 3 months for my next appointment, we will see if it is working for me or not. If not, I will hopefully get him to appeal it to the insurance.
But first things first - I have to get this pre-auth working and get some Enbrel in my hands........
I'm not really as upset as I thought I would be about all this. I think a lot of it has to do with reading about everyone else's similar problems with getting their meds and insurance problems lately. At least I feel like I am not the only one this stuff is happening to!
Thanks for all the nice comments and support everyone! It really is a huge help!
let us know as soon as the first box of Enbrel arrives - hopefully much sooner than later
Ros
Took no more then couple days for my Enbrel.
I'm sure depends on office, insurance etc..
Now with the Orencia it took weeks because of mistakes. Orginally the office said couple days & no longer then the end of the week.
Then of course the insurance requested additional info.
CT, really hoping Enbrel works for you.
Once your set perhaps asking the nurses hotline how long you should give the Enbrel?
That way with any luck you can give your RA doctor heads up to start the athorization for the Humira instead of waiting if the Enbrel does not help .
It's not like Humira's a new medication for you.
The thing I liked about the Enbrel is the liver is not at risk compared to some of the other meds.
Wouldn't hurt to try. He owes you at least that much after his offices lack of communication.
When I set up my first shipment of Enbrel the mail order (Optum RX)
Automatically enrolled me in the co pay assistance program. After couple questions to see if I qualified. That was a huge help.
Here's to success, fingers crossed for you.
Let us know how it goes.
Truly hope this office works with you.
Sammy
sammyo1 - that interesting to hear about the Enbrel and liver. My liver count has been up and my Rheumatologist is insisting that I see a Gastoenterologist (appt March 31st). My liver counts had spiked a bit more after starting the Humira - maybe the Enbrel would perhaps be better. If I ever do in fact get the Enbrel, maybe a comparison can be made against when I was on the Humira.
At this point I will take anything. I didn't realize how much the Humira was actually helping me - I guess because the effect comes on gradually. Thankfully the effect of going off the Humira has been gradual also, but I am really starting to feel it the past 2 weeks. Most marked for me is the return of the fatigue/fog. I was actually to the point of not needing those mandatory naps during the day for a little bit there.....
After the blunder with my Humira and now my blood pressure meds, I am going to take your advise. Actually the first thing I did when I got home was to call the insurance company about the process of getting the Enbrel so I know what to expect. The few times that I have called them they are always very pleasant and helpful.
I kind of hate calling and calling, but I guess I will have to get over that. I only called twice about the Humira problem - I get easily frustrated when dealing with people. And I think I am very good at being diplomatic and keeping my cool - I just have to be a bit more persistent.
And I can agree that it can easily be the doctor themselves holding these things up. I usually will start the conversation with the office staff with "I know this probably isn't your fault, but......."
I recently bought new insurance through the ACA. I called the company I had been with to ask about a couple of things. Their 800 number said that "hold times currently exceed 60 minutes" and they would TRY to respond to emails within 5 days. Needless to say, I went with another company.