Specialty drugs for autoimmune disease-Psoriasis need help
Hi. We're in the US and I'm desperate to get my husband help. He has severe psoriasis and was switched to a biosimilar Hyromiz this past March after being on Humira for 10 years. The prior authorization process took so long we didn't get the injection until May.. it was so bad he took a starter and it still didn't clear up all the way. Now when it's our time to fill his maintenance dose which is one shot every two weeks they're out of stock at our preferred pharmacy. Note:we have Aetna health insurance plan through Walmart with Optum pharmacy benefits. Walmart forces you to get all specialty drugs from them only. Walmart has it back ordered for two months now. The doctor refuses to write a script for another biosimilar and it seems that CVS specialty pharmacy Caremark are the only pharmacy to have it in stock… (if you google cvs Caremark humira/hyromiz you will see why) anyway optum told us we could get an override since it's out of stock and now it turns out that got denied because we went out of network already with Walmart… even though optum specialty doesn't have it and wouldn't fill it anyway due to our plan stipulations. I'm at a loss and don't know what else to do or who to call. If this goes on any longer he will need take leave from work it's so sad they get away with doing this kind of stuff especially when so many patients depend on these drugs that cost $12,000 a shot. Any advice or suggestions are welcome.
submitted by /u/Yoshic12
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