Answer Summary

Members rallied around someone whose insurance denied Humira in favor of a cheaper biosimilar, sharing the frustrating reality that insurance... Read more

Members rallied around someone whose insurance denied Humira in favor of a cheaper biosimilar, sharing the frustrating reality that insurance companies often prioritize cost over proven effectiveness, with approval battles taking weeks of back-and-forth between doctors and insurers. Several members described their own forced switches to biosimilars like Hyrimoz and Simlandi, with one sharing the heartbreaking outcome of waiting eight months to prove the biosimilar failed before getting approved for a different medication, during which time their joints deteriorated permanently. A recurring theme was the importance of appealing the decision with support from a rheumatologist, staying persistent through the process, and understanding that insurance may require proof of biosimilar failure before approving the original medication.