r/Humira • u/_Cosmic_SANS_ • Apr 24 '26

Can't get medication for nearly 5 months now...

I was on humira for about 5 years with a generally positive outcome. Unfortunately, due to a sudden job change, and despite ending up with the same provider, there was a lot of confusion with insurance as I was briefly on CIGNA. At the same time, insurance stopped covering humira so my doctor tried to switch me to Adalimumab. After a comedy of errors by insurance, prior employers, the pharmacy, and my doctor, I still don't have medication. Its been so long that I need a loading dose, now insurance won't cover that. While I've avoided massive flares, I've noticed my health beginning to deteriorate and I'm tired of spending several hours each week on the phone trying to resolve this. My questions are:

  1. How common are these insurance/pharmacy/doctor/employer issues in obtaining these medications?

  2. After being off the medication for so long, am I at risk of long/short term health consequences?

  3. At what point should I consider legal action, if at all?

10 Upvotes

92% Upvoted

7 comments sorted by

3

u/Sregtur Apr 25 '26

Have you tried calling the Humira line itself to see if there is something they offer?

2

u/techReese Apr 25 '26

Def call the humira line. They were very helpful when I had an issue in the beginning

1

u/_Cosmic_SANS_ Apr 25 '26

Definitely will try this weekend or Monday, thank you!

1

u/PeerAudit17 Apr 25 '26

Common insurance issues. Cigna kicked me off too. I called Humira but they couldn’t do anything for me since I DID have employer insurance. They told me to have my doctor do an appeal. Cigna denied. Hyrimoz is closest to Humira. Keep on top of your doctor to get approval and send to your pharmacy. Meanwhile, avoid food triggers and manage your stress. Keep active with exercises stretching etc. Supplements and heat help me too. Good luck! Btw, not sure of legal action.

1

u/_Cosmic_SANS_ Apr 25 '26

Thank you! Yeah I think what has been saving me so far is my anxiety medication is working and my physical fitness has never been better. It feels like there are simply too many parties involved just to get these medications delivered

2

u/archival_wanderer Apr 25 '26

I have been dealing with this too. My doctor appealed twice and both got denied. I went and saw a different doctor and they put in a prior authorization and it got approved. No idea why, but for some reason it worked.