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#278190 - 06/13/17 12:59 PM Anyone Change Insurance While Taking a Biologic?
ThreeG Offline
Registered Visitor

Registered: 11/10/16
Posts: 22

I am reeling after learning that my company is likely changing insurance policies before my next Remicade dose. It took me 5 months to get approval to start, and I just had my first non-loading dose. It has been revolutionary for me, and this is a huge blow.

Has anyone been through this? How long did it take to get pre-approval with a new company, and what should I expect if I have to go a long time before another infusion (I can't afford to pay out of pocket)? Also, I think I also have to re-do all the drug company aid stuff, too, right?

Thanks in advance for any insight!

#278191 - 06/13/17 02:37 PM Re: Anyone Change Insurance While Taking a Biologic? [Re: ThreeG]
Bella22 Offline
Registered Visitor

Registered: 04/22/12
Posts: 124
Loc: Southeastern Massachusetts
This happened to me with humera. Because I had been on it previously, I did not have to go through the pre authorization process. Hope it's the same with you. My co pay was the same and the change of insurance was seamless. Wishing you luck!!
Dx: Spondyloarthropathy/Connective Tissue Disorder (2/12), AS (9/12) HLA B27 negative, sacroilitis on x-ray - Current Meds: Methotrexate (20 mg), Leucovorin (30 mg), Protonix, Relafen, Vicodin and Tramadol PRN, Enbrel (9/12) Humira (7/15)

#278196 - 06/13/17 08:58 PM Re: Anyone Change Insurance While Taking a Biologic? [Re: ThreeG]
Banana Offline
Registered Visitor

Registered: 07/23/06
Posts: 6500
Loc: New York
No,I did not have to start over because it is a medication you are already on. The whole preauthorization is when you start a med.

Hope it keeps working for you for many many years.

Actema IV once a month (with pre loading for allergic reaction), Cymbalta x1 daily, Arava 20mg daily. Diagnosed with AS in 2004, suffered undiagnosed since 1982.

#278205 - 06/14/17 07:56 AM Re: Anyone Change Insurance While Taking a Biologic? [Re: ThreeG]
WhiteCell Offline
Registered Visitor

Registered: 05/31/10
Posts: 1319
Loc: Whidbey Island WA
If you are able to stay with the same Rheumatologist make them aware of the issue without delay. If not get a referral and get an urgent appointment where you detail the issue. You may have to press this with everyone involved.
Since 18 years old - began as Reiter's Syndrome. Diagnosed with Ank Spon 2001. Remicade since 2002 - 5mg/kg every 7 weeks. 8 hour Tylenol and hot tubs for pain.

Severe Right Eye Glaucoma-
Trabeculectomy/lens replacement 2006.
DSEK Cornea Transplant October, 2009.
Ahmed Shunt June, 2016.
DSEK Cornea Transplant, November, 2016.

Supra Ventricular Tachycardia. 2004.
Cured by RF ablation 2006.
Cardizem 240 CD.

ICU RN Seattle, WA

~Grasp The Challenge and Succeed~

#278206 - 06/14/17 09:30 AM Re: Anyone Change Insurance While Taking a Biologic? [Re: ThreeG]
ThreeG Offline
Registered Visitor

Registered: 11/10/16
Posts: 22
Thank you all. The timing is what has me worried. My next infusion is scheduled for the day AFTER the new insurance would start. I'm waiting for a call back from my infusion center to see if there is any hope we can move it up two days and what else I need to know.

The plan currently on the table doesn't include my doctor (or any rheumatologists in my county). Thankfully, I am fortunate enough to work for a company that cares about that kind of thing, so I am crossing my fingers that we can find a viable plan that does. Then there's the matter of the resetting deductible... It is so frustrating!


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