Spondylitis Association of America Forums General Discussion General Message Board for Ankylosing Spondylitis and Related Diseases Humira refills and insurance restrictions

Just wondering if anyone else is having this issue.

It seems that either the insurance or pharmacies have tightened up policies and will only refill scripts if you have 10 days or fewer of medication on hand.

I get Humira through a specialty mailorder pharmacy (Accredo). Due to insurance restrictions, this is the only pharmacy I can use for specialty medications.

Normally, I like to schedule my shipment for when I have one dose left on hand. This way, if there is a problem with the needle or I hit a vein and need to discard it (this has never happened), I have a fallback. I once had a rather bent needle and was able to use it, but it made me realize things can go wrong.

Now, they won't deliver til I have ten days on hand. The problem? The medication is taken biweekly, so if I have one dose left, technically that is 14 days supply. Hence, no shipment can be scheduled til I have used my last dose.

I tried to explain that this only makes sense by computer logic, and that in HUMAN logic they are telling me I can't reorder til I have 0 days supply left. No luck.

I believe this is an insurance restriction and not a pharmacy one, since I had a similar issue with filling a normal 30-day once-daily prescription at CVS.

However, in practical terms, the policy is stupid.

Anyone else running into this? Any possible solutions? I really hate waiting til my meds are all gone to get the next shipment. The woman at Accredo says I must talk to my benefits manager for my employer.

Thanks.

humira will semd you a new pen next or 2nd day air if you have a bad pen.

just fyi

Yes, we are having the same issue with my daughter's Humira. For the past two months, it has arrived late too. It is very frustrating!

Carrie, that is helpful to know. I will remember that if I ever need it.

Lynn, sorry to hear you are having issues too, but glad I'm not alone. Even with regular once-a-day meds, it's silly: what if I am heading off for vacation or something and want to get it early? I stopped at the pharmacy to fill a script for one of the dogs and went to refill one of my own while I was there, to save a trip, and could not; now I have to go back next week. Talk about wasting time and trips!

I can see with controlled substances, but normal meds?

Some insurances will give a one-time vacation override to get refills before a trip, but not sure with the mail-order pharmacy to have one on hand. I use Briova mail-order for Cimzia and they say to let them know when it's time to take my last shot on hand and they will process the next shipment. I used them when I was on Humira and never had to miss a dose due to them being late. Realize that you have only the one choice with your insurance. Sorry you are getting the frustration.

I take Humira weekly and get it from Accredo. My last delivery was about 3 weeks ago. I usually get 12 pens at a time. So far I have not had an issue and they have been sending it to me for about 18 months. A few times they did not even ask how many I had left and one time it was three pens. I am not really going to worry about it yet.

Mark, thanks for sharing and glad you aren't having issues. I'm quite confident it's not Accredo, but my insurance, who has the new requirement. Since CVS gave me the same answer for an entirely different script...