u/CatQueen94

Has anyone had any luck with using a manufacture direct program? Like bypassing their insurance altogether and using the program. I'm specifically looking at Johnson and Johnson.

My insurance won't cover the milligram I need and i'd rather not have to have my rheumatologist fill out another prior auth.

I know it's kind of a long-shot but after talking to their caseworker I meet requirements and if it allows me more time then I see no reason not too.

Has anyone had luck with using one of these programs for their autoimmune meds.

I would love some opinions on medications. What is everyone opinions or Cosentyx, Taltz, and Embrel. My insurance company will gladly cover 100mg of Simponi have a approved prior auth for that.

However they won't cover, approve or pay for the 50mg. I've been on a yo-yo and hours worth of phone calls trying.

So what is everyone's opinions.

I'm currently in a hopeless pit of despair.

I failed Humira. Rinvoq half-worked. I'm only 32 this year.

I just need to sit in here and scream. My original rheumatologist offered Cosentyx and Taltz for my next streps after failing both Humira and Rinvoq.

I asked for Simponi instead as the last time my inflammation was under control was with Humira. I've seen Embrel isn't great for axial symtoms, I hate Cimiza's injector so Simponi for the next TNF. I don't know if i'll get months, or years but i'm just trying to by myself more time.

I listened to his Rinvoq suggestion and i've been in high speed autoimmune crashout since March.

Can't sleep, hip and knee hurt. Spine hurts, shoulders hurt, hands and fingers hurt so bad instead of my hand cream to soften i'm using Voltaren for pain relief.

Anyway early April I asked for Simponi and he agreed with my reasoning and sent RX to the pharmacy.

Only he sent it for 100mg and a 3 shot loading dose. It takes his office a week before finally sending my prior authorization to my insurance. They sent the Rinvoq prior authorization same day and it was approved same day.

It takes my insurance a week to sit on Simponi and they approved the 100mg dosage, but clarify that my condition doesn't need the 3 week loading dose.

Should be all good right? You would be wrong call up my speciality pharmacy to try and schedule it since i'm out of Rinvoq. (Yeah, my face is a great mix of flaky scales and acne)

Only to be told 100mg not approved for your condition get them to change it to 50mg.

At this point I have talked to every single member of my rheumatologist's staff and spend 2 hours on the phone with the specialty pharmacy trying to get this in my hand.

I finally call my insurance after Walgreen's says hey insurance verification says no.

Well friends insurance is telling me I need another prior auth for the 50mg dosage and Karen instead of offering to call my doctor and let them know hey so here's the situation she spends 10 minutes lecturing me about NDC codes.

I am well aware what an NDC code is. The whole reason I called was so that someone could explain to his office need a new prior auth. No offer to call my doctor, my pharmacy, no hey I can happily rush that prior auth, I can mark it as urgent anything.

I don't really want Simponi. I just want some relief from the pain. I'm eating eddibles and that helps the pain level but it's not doing crap for my worsening inflammation.

Lab proof my CRP while on Rinvoq is by far my worst while on biologics. It still doesn't matter because I keep getting red taped and nobody seems to care how much i'm struggling.

I did not ask for autoimmune. It's not like i'm going to enjoy Simponi...

When did healthcare employees get to be so rude and unempathetic.

I'm so so fed up with it all!!!!!!!!