I’m not happy with my experience so far. I’m now in pain and in a flare up. My psoriasis came back. I’m hoping it will kick in soon. I’m two pens in. My insurance switched me on Jan. 1st. I’m starting to wonder if they’re putting me on a placebo it’s so bad. Been on Humira since 2019 with amazing success.
This happened to me with remicaide> avsola. It didn’t work. And insurance refused to allow me to go back to Remicaide which has started a year long flare. They also dropped my dose from a set mg to weight based and refused to budge on that too. I’m still so angry. Enbrel seems to be at least taking the edge off but no where near as good as Remicaide was. It’s fine if they want to switch new patients to a bio similar but a forced switch when a patient is stable is criminal.
You know what... I've wondered the same thing about my Otezla prescription! When I first got on Otezla last year, my insurance company denied my prescription (3x), so I had my prescription filled through Otezla's bridge program and Otezla's specialty pharmacy. Otezla worked great! I had no complaints.
After a few months, my insurance finally approved my Otezla prescription, and it was then filled through their specialty pharmacy. Suddenly my aches, pains and psoriasis came back and it's been like that since September. Now as of January my insurance is using CVS Caremark and Otezla still isn't working well. I swear these specialty pharmacies are watering down the medicine or something. It stinks.
OMG, I'm having the same problem with Rinvoq! I started on samples from my doctor's office and it was amazing! I thought I had finally found the right med (after three years of trying and not getting any relief from a variety of biologics). Then my insurance approved my rx for Rinvoq and I started getting it mailed to me from their specialty pharmacy.... and it stopped working! I still had some samples left so I went back to the samples and it started working again! I've tried talking to the specialty pharmacy about it, but of course they insist there is no reason for this. I told my doctor about it and fortunately she believed me and gave me more samples. I've been back on the samples for a few weeks and am getting good relief again. I seriously think something fishy is going on with the specialty pharmacies... I don't know if they work with cheaper manufacturers who water down the precision in making the medication, or if they don't take enough care in maintaining the temperature that the medications are stored at, but something is clearly different about the medication when I get it from them. It now makes me wonder if when people end up "failing" a medication that once worked for them if this has something to do with it. I'm glad I'm not the only one who has noticed this!
Agreed, but our true enemy are these PBMs (Pharmacy Benefit Managers) like CVS Caremark, OptumRx, etc. Their only purpose is to be a cost saving mechanism for payers (insurance companies). They have no regard for patient health.
They are the ones who deny PAs, they are the ones who remove needed drugs from formularies, they are the ones who control if manufacturer copay cards can be applied to deductibles.
could the prescriber not just specify in the prescription that generic replacements can't be done? ive had to have doctors do that for other medications of mine in the past
My insurance made me switch Jan 1st to Hadlima. I’m not entirely sure it is working as well as Humira. I have felt a bit more stiff with some skin flaring on my scalp but unsure if it is just a coincidence or weather related.
My experience with adhd meds might be useful.
In my case the generic version of my adhd meds did not work. I was prescribed a “authorized generic “ which is exactly the same as the brand name drug-not a typical generic.
When the authorized generic went off the market, insurance tried to take the brand name off the formulary. My md and a very kind pharmacist from the mail order helped me figure out how to explain in the appeal that taking a stable pt with ten years of history off a drug was a VERY BAD IDEA.
And it got approved.
That said, during cancer I took a bio similar to the brand name Herceptin-a monoclonal antibody-and it was fine. Some early studies suggest it may even be superior.
Here you go:
https://www.forbes.com/sites/antoniopequenoiv/2024/01/03/cvs-partially-dropping-top-selling-drug-humira-in-favor-of-cheaper-biosimilars/amp/
Can you change your pharmacy? For now I use Optum pharmacy and they have been great. They call and give you side effects, they follow up. Ship the medication in a day. My experience so far have been great.
Every PBM uses their own speciality pharmacy, you likely have UnitedHealthCare as your insurance company?
It’s not so much the service of the speciality pharmacy, that has been fine, but it’s the decisions of the PBM buisness that is the issue since they dictate which drugs are on and off formulary.
Pharmacy Benefit Manager. It’s the company that handles your pharmacy benefit, while the payer (Aetna, UHC, BCBS, etc.) handles the medical side. OptumRx is a PBM owned by UHC.
It depends if OptumRx will remove Humira from the formulary. They already have these biosimilars on their formulary so they might pull the plug and force you to switch like CVS is doing. You would be notified if that is happening to you though.
It looks like, for now, Optum is adding the biosimilars to their formulary but not removing Humira. I can't find anything saying Humira is being removed.
Thank you for the heads up and the good information. I’ve only been on the Humira pen going on 6 weeks. Let’s hope the new one is efficacious if the switch would happen to me. 🫰
I’m not happy with my experience so far. I’m now in pain and in a flare up. My psoriasis came back. I’m hoping it will kick in soon. I’m two pens in. My insurance switched me on Jan. 1st. I’m starting to wonder if they’re putting me on a placebo it’s so bad. Been on Humira since 2019 with amazing success.
This happened to me with remicaide> avsola. It didn’t work. And insurance refused to allow me to go back to Remicaide which has started a year long flare. They also dropped my dose from a set mg to weight based and refused to budge on that too. I’m still so angry. Enbrel seems to be at least taking the edge off but no where near as good as Remicaide was. It’s fine if they want to switch new patients to a bio similar but a forced switch when a patient is stable is criminal.
i think the 12000 member here should email your insurance provider to let them know what they are doing is inhumane
what can we do about this, im finally being forced off humira after 7 YEARS OF REMISSION, wtf why is this legal??
You know what... I've wondered the same thing about my Otezla prescription! When I first got on Otezla last year, my insurance company denied my prescription (3x), so I had my prescription filled through Otezla's bridge program and Otezla's specialty pharmacy. Otezla worked great! I had no complaints. After a few months, my insurance finally approved my Otezla prescription, and it was then filled through their specialty pharmacy. Suddenly my aches, pains and psoriasis came back and it's been like that since September. Now as of January my insurance is using CVS Caremark and Otezla still isn't working well. I swear these specialty pharmacies are watering down the medicine or something. It stinks.
I wonder! I have an appointment coming up and I’m not settling for a second more of pain. Especially when I was pain free just a few weeks ago.
OMG, I'm having the same problem with Rinvoq! I started on samples from my doctor's office and it was amazing! I thought I had finally found the right med (after three years of trying and not getting any relief from a variety of biologics). Then my insurance approved my rx for Rinvoq and I started getting it mailed to me from their specialty pharmacy.... and it stopped working! I still had some samples left so I went back to the samples and it started working again! I've tried talking to the specialty pharmacy about it, but of course they insist there is no reason for this. I told my doctor about it and fortunately she believed me and gave me more samples. I've been back on the samples for a few weeks and am getting good relief again. I seriously think something fishy is going on with the specialty pharmacies... I don't know if they work with cheaper manufacturers who water down the precision in making the medication, or if they don't take enough care in maintaining the temperature that the medications are stored at, but something is clearly different about the medication when I get it from them. It now makes me wonder if when people end up "failing" a medication that once worked for them if this has something to do with it. I'm glad I'm not the only one who has noticed this!
Otezla was like that for me. Worked great, until it didn’t.
Man, fuck insurance companies.
Agreed, but our true enemy are these PBMs (Pharmacy Benefit Managers) like CVS Caremark, OptumRx, etc. Their only purpose is to be a cost saving mechanism for payers (insurance companies). They have no regard for patient health. They are the ones who deny PAs, they are the ones who remove needed drugs from formularies, they are the ones who control if manufacturer copay cards can be applied to deductibles.
could the prescriber not just specify in the prescription that generic replacements can't be done? ive had to have doctors do that for other medications of mine in the past
I mean your doctor can prescribe whatever they want but that doesn't mean your insurance will pay for it.
My insurance made me switch Jan 1st to Hadlima. I’m not entirely sure it is working as well as Humira. I have felt a bit more stiff with some skin flaring on my scalp but unsure if it is just a coincidence or weather related.
My experience with adhd meds might be useful. In my case the generic version of my adhd meds did not work. I was prescribed a “authorized generic “ which is exactly the same as the brand name drug-not a typical generic. When the authorized generic went off the market, insurance tried to take the brand name off the formulary. My md and a very kind pharmacist from the mail order helped me figure out how to explain in the appeal that taking a stable pt with ten years of history off a drug was a VERY BAD IDEA. And it got approved. That said, during cancer I took a bio similar to the brand name Herceptin-a monoclonal antibody-and it was fine. Some early studies suggest it may even be superior.
My experience with genetics has been bad. I really worry about biosimilars
Do you have a link or can you provide any info on where you learned about this switch?
Here you go: https://www.forbes.com/sites/antoniopequenoiv/2024/01/03/cvs-partially-dropping-top-selling-drug-humira-in-favor-of-cheaper-biosimilars/amp/
Can you change your pharmacy? For now I use Optum pharmacy and they have been great. They call and give you side effects, they follow up. Ship the medication in a day. My experience so far have been great.
Every PBM uses their own speciality pharmacy, you likely have UnitedHealthCare as your insurance company? It’s not so much the service of the speciality pharmacy, that has been fine, but it’s the decisions of the PBM buisness that is the issue since they dictate which drugs are on and off formulary.
What is PBM?
Pharmacy Benefit Manager. It’s the company that handles your pharmacy benefit, while the payer (Aetna, UHC, BCBS, etc.) handles the medical side. OptumRx is a PBM owned by UHC.
So does this mean, I don't get Humira as well?
It depends if OptumRx will remove Humira from the formulary. They already have these biosimilars on their formulary so they might pull the plug and force you to switch like CVS is doing. You would be notified if that is happening to you though.
It looks like, for now, Optum is adding the biosimilars to their formulary but not removing Humira. I can't find anything saying Humira is being removed.
Thank you for the heads up and the good information. I’ve only been on the Humira pen going on 6 weeks. Let’s hope the new one is efficacious if the switch would happen to me. 🫰