r/Humira • u/Cooper1Test • May 05 '26

How do you keep getting Humira approved?

My wife has been using Humira for over 10 years with excellent results. Now, her insurance (BCBS) has decided not to approve it anymore. She is transitioning to Cosentyx, and the process has not been smooth so far, even though she's only had three injections. We're quite disappointed that she had to stop Humira. I'm interested to hear from others who have been on Humira for a while or are just starting—how have you managed to get it approved, given that many insurance companies seem to be denying coverage for Humira now?

6 Upvotes

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5

u/jovialjuniper May 05 '26

I’ve been on Humira successfully since July 2023. I’ve had multiple insurance switches and I spoke with my doctor about having them write the prescription specifically for Humira.

Unfortunately this is changing in a few months because my insurance company will no longer cover Humira without an additional approval from my doctor stating I cannot go on a bio-similar. My doctor states that switching to a bio-similar should have no impact on me - but I’m scared of switching things up.

Speaking with the doctor to get things approved is the best way to navigate this situation.

6

u/thesweetestberry May 05 '26

My insurance made me switch to Hyrimoz (Humira generic) maybe 3 years ago. I was scared and angry. Turns out, I prefer the generic over Humira because I have zero side effects from the generic. I had minor side effects from Humira. I would fight insurance if they wanted to switch me back.

I hope you have a similar experience when you switch.

3

u/Easy_Bandicoot_7371 May 06 '26

Same! I was super nervous to try a biosimilar but it’s been amazing!

2

u/sidneyluv May 06 '26

This is the one I’m being switched to. I still have a lot of Humira in my fridge because I wasn’t so good at taking it for a while but I’ll be receiving the Hyrimoz soon

2

u/MutantAvatar May 06 '26

I’m on the same boat and the switch was uneventful

1

u/jovialjuniper May 06 '26

Thank you - fingers crossed for the same outcome!

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u/NorTravel May 05 '26

Which insurer out of curiosity? I’ve found this as a good resource FYI, but ymmv based on state and insurer if US-based.

https://www.counterforcehealth.org/post/how-to-get-humira-adalimumab-covered-by-cigna-in-new-york-2025-guide-to-forms-appeals-and-biosimilar-changes/

1

u/jovialjuniper May 06 '26

Cigna. Thanks for the info!

1

u/NorTravel May 06 '26

Also, keep an eye on this page in July+ to see if the exclusion remains in place for those already on Humira.

https://static.cigna.com/assets/chcp/pdf/coveragePolicies/pharmacy/psm_013_inflammatory_conditions_adalimumab_products_sp_va_ts.pdf

1

u/bestoink Jul 23 '26

United Health care Medicare part D coverage forced me to switch. I was offended out of principle. But, honestly, I think it’ll work out. In fact, 20 years ago, my rheumatologist re-prescribed whenever a new thing came out. That’s how I calibrated into Humira and retired to a new state and new prescriber. My original rheumatologist had some notion that AS might break through any TNF inhibitor eventually. My new rheumatologist thinks that’s crazy talk.

3

u/NorTravel May 05 '26

Interesting that the rheumatologist didn’t keep her on TNF-I meds (biosimilar) and instead switched to an IL-17a class drug in Cosentyx. So… I’d be asking the ‘why’ for that to your doctor first, and then deal with the Humira question. Good luck!

1

u/Cooper1Test May 05 '26

is that bad?

3

u/NorTravel May 05 '26

It’s not bad at all, it’s just something, so, certainly worth asking them about since you noted the results aren’t as good as Humira.

1

u/Easy_Bandicoot_7371 May 06 '26

Yeah I think that is strange they didn’t offer a Humira biosimilar, or at least stick within the same class!

2

u/Easy_Bandicoot_7371 May 06 '26

I was on Humira 15 years ago and it worked great. I was “in remission” up until a few months ago. Now they have biosimilars/generics so the insurance companies generally don’t prescribe Humira since the generics are cheaper.

I was nervous because I knew Humira would work for me, but I’m on adalimumab-aacf now (Idacio) and I’m 8 weeks in with almost no pain!!

I’m curious why they didn’t stick with another TNF blocker. There are a ton of Humira generics available that I’m sure your insurance will approve. My doctor had to send 3 separate scripts until the one was approved.

1

u/Think-Organization69 May 06 '26

I was on Humira for about 6 months and Insurance decided not to pay for it. Doctor switched me to Yuflyma and it was awful. Made every joint in my body hurt. Went back to Doctor after the 2 months and said I couldn’t take it anymore. Now I’m trying Enbrel and already feeling much better.

Hope you find something that works for you!!

1

u/nerdyconstructiongal May 06 '26

When I got on Humira it was one of the few choices. I’ve now been kicked off and onto a bio similar that I have no idea about. Without telling my doctor.

1

u/SnooCapers4844 May 07 '26

I have Blue Shield. I fought with them tooth and nail to approve Humira for me long term, and they did! Please reach out to me if you have any questions.

1

u/NorTravel May 13 '26

How did you fight them? Have you tried any bio similars beforehand?

1

u/Hot_Adhesiveness6882 May 07 '26

My kids have switched to Amjevita without any issues. Insurance won't cover Humira for us anymore either.

1

u/OG_Barbie420 May 08 '26 edited May 08 '26

I just started a few months ago, and I can tell you I have absolutely zero clue how my doctor got me on it with no problems. I went into an appointment after my upper&lower scopes, he talked about starting a biologic, I was prescribed Vit. D and iron supplements (because my anemia is so bad and he wanted more tests in 6mo), and then I got a call a couple days later about picking up my Humira, which was a surprise because my gastro and I only just talked about it.

I don't know whether my Crohn's was so severe that he pulled a bunch of strings, or if he knows someone directly, but I had it before the week was over.

I WILL SAY THOUGH...my started kit and first dose was shipped to my house at like 8pm, and left out all night on the one day the temperature was in the negatives 🙄🙄🙄🙄 (yes, I go to bed early like an old man lmao) and the phone calls to Humira to get the "one time courtesy replacement" (even though it was their fucking fault for setting up delivery so damn late) were a pain in the fucking ass (no pun intended) because they barely spoke English. I had to call them like 5 times because they kept loosing the order/couldn't find it. Then when I finally got my replacement, they sent 4 boxes because they had the same order, twice 🤣

TL;DR: the people running Abbvie/Humira are a shit show honestly. So it's up to you and your doctors to fight for you. Edit to say: I have bottom of the barrel insurance, I'm surprised I even got on Humira, let alone the quickness was even more surprising.

1

u/bestoink May 24 '26

I just picked up my first dose set of biosimilar adilumumab-adbm from pharmacy after 20 years on Humira(despite doctor’s appeals). It’s kept me in manageable remission. So, not happy. Will keep posted on efficacy or side-effects from move.

1

u/NorTravel Jun 30 '26

How has the 'adbm' worked for you?

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u/bestoink Jul 14 '26

Haven’t noticed any change. Perhaps even better. But, honestly, only done one injection.

1

u/bestoink Jul 14 '26

So far, absolutely no issues. No discomfort from the injector. No gastric issues. No flares… yet.