Complaint Review: Humana

Janumet itself IS in the Humana Formulary as a Non-preferred brand name drug. The problem is that it requires a Prior Authorization to be dispensed. That's where the problem lies, in that the review board didn't have enough information concerning previous treatments and the drug itself to authorize it. I would suggest, in the future, having your doctor contact the review board. you can also have the agent call the company's help lines with you there to dicuss the necessary steps it would take and to check on drug status.

For future reference, most companies do make their formularies available online without joining. In Humana's case, the formulary can be found on the Humana.com website under the heading "Medicare Drug List" in the member's section.

Previous therapy options that are not successful, showing a medical history where Janumet is the most effective and, in some cases, only effective treatment option would result in a Prior Authroization being entered. Always check with the companies before purchasing the plan, however. I handle a lot of these calls daily, and it's a pretty regular to find out the first phone call concerning a problem is the first time a member is made aware of the necessary procedures to get this done. Agents, unfortunately, don't have all the procedural training company employees do get, but remember that buying health insurance is no different than buying a car or house...you always want to ask every question as soon as possible.

If you do have a complaint still, most companies have Grievance and Appeals departments you can contact. These departments report member complaints to the Center for Medicare and Medicaid Services on a regular basis.

Good luck, and God Bless.

My wife has Type-2 Diabetes. I manage it, because she did not.

She usually gets 5 to 6 units of Humalog at the start of every meal. At picnics she gets 4 units at the start of her meal.
She gets 24 units of Lantus once a day.
I meter her 2X per day.
Her A1C is always between 5.4 and 5.9, which is good even for a non-diabetic.

Lantus and Humalog should be on any formulary.

Control of diabetes IS possible. Using the very-fast-acting Humalog with the very-slow-acting Lantus provides exact control.

''He already suffers from nerve damage in his feet due to uncontrolled diabetes.'' suggests that it is time to get serious!

Hi iI have to say that for me Humana has been great for me since I joined 03/2003,I had a problem with prescription my doctor gave me but Humana would pay for It and It was $350.00 a month so called Humana and they said that It was to new only out for less than 2 months so they would not pay,So I called Walgreen's and they told me that every Ins Co would not yet pay for It so my doctor waited a couple months and then no problem.I'm sorry and feel your pain but this Is not just a problem with Humana .

Janumet is a combination of Jenuvia and metformin. Metformin IS in most drug formularies but Jenuvia is not. I asked bothe the pharmacy and my diabetic doctor why it is not in the formulary. They both said that 1. there was not enough research, and 2, there ARE other drugs out ther that DO basically the same thing. I think the insurance salesperson has no way of knowing that is in the formulary. I am sure that IF your doctor has gtried everything else, including insulin, and it did not work, and he could prove that janumet did work, then Humana might put it in the formulary. I take metformin, but if I wanted to take jenuvia, I would have to pay for it out of pocket, that is assuming I could even get my doctor ot prescribe it.

...But there's really not enoguh information. Had your doctor tried previous medications to help control your diabetes, or did he just come out of the gate prescribing Janumet? See, there are no alternatives for the brand name drug, Janumet. No generics. Nothing. There is, at the current, no drug in the Medicare Formulary that matches it, but that doesn't mean there aren't combinations of drugs.

The most common complaint is that our review board doesn't know better than the doctor/pharmacist who prescribed the drug. The fact is the review boards are made up of medical professionals. If the case was that your husband had not been on any previous drug combos or therapy combos, the review board was denying because they thought there may be a more cost-effective way to control your husband's diabetes, and that this would be beneficial to you and your husband as well.

If your husband had been on other treatments, they may have wanted to see the difference in results.

Normally prior authorizations aren't huge problems because a lot of doctors will try the lowest cost prescriptions and therapies first. A lot of doctors do this in an effort to be certain the company will pay, and to build an effective case for a prior authorization to be entered.

There's really not enough information to give a reason Janumet was not authorized, not that I expect your husband's medical history to get posted for a complaint. It could have been any number of reasons, from doctor error/omission to the review board wanting to see more proof Janumet was the only prescription that worked.

I do hope you've obtained health coverage you're satisfied with, however, and wish you the best of luck.

I worked for INhumana for almost a year. This lady has ABSOLUTELY every reason to be upset, and it has NOTHING to do with lack of knowledge. Our Seniors depend on us, to give them CORRECT information, but unfortunately, this company in particular, has no regard for the Consumer, but for what they will pay them! I know first hand, that they have a HORRIBLE turn around rate with emloyees, its at about 60% right now, infact I was in the 1st hiring class that opened up HUmana in AZ. Now to date, out of 36 of us that started that class, there is only 11 of them left. Most of the Supervisors do not have any idea what they are doing, much less know anything about the products being sold, for example, they just started having everyone sell Medicare Supplements and NO ONE in that place has ever sold one, nor do they have any information on them, so we as Agents had to research as much as we could so that we could in turn give CORRECT information to the Prospects, but not many of us researched anything especially not the Supervisors, so needless to say, what ends up happening is we get a caller that needs information that we do not know ourselves, so we go to our Supervisors, who could care less about us, the caller or our licenses for that matter and gives us whatever answer they feel like giving us at the moment, and thats the answer the Consumer gets as well. If anyone happens to end up at the AZ call center when they call in, you're better off, not asking to speak to a Supervisor, because they're the most ignorant ones in there, except for teo of them and their names are Keysha and Kris. They actually have taken the time to research our plans and they have a pretty good knowledge of the products, but if you get anyone else GOOD LUCK! So to wrap this up, this poor lady, unfortunately is just one of many people who get wrong information because all Humana cares about is getting "bodies" in their cubicles, and money in their pockets, how they do it is of no concern to them at ALL!!!

JANUMET is indicated as an adjunct to diet and exercise to improve
glycemic control in adult patients with type 2 diabetes mellitus who are
not adequately controlled on "metformin" or "sitagliptin" alone or in
patients already being treated with the "combination of sitagliptin and
metformin".

Basically the doctor had to show this previous failure of the FDA's recommended previous drug theory over a period of 6 months to approve this medication. Most likely the Doctor got samples from a drug rep pushing this drug and did not follow the proper approved dosing guidelines recommended by the drug research and the FDA dosing guidelines.

http://www.fda.gov/medwatch/SAFETY/2008/Jan_PI/Janumet_PI.pdf

Under 1860D-13(b) of the Social Security Act and 42 C.F.R. 423.46 and 423.56(g), the
Secretary or his or her designee imposes a late enrollment penalty (LEP) if there is a continuous
period of 63 days or more at any time after the end of the individual's Part D initial enrollment
period during which the individual was eligible to enroll in a Part D plan, but was not enrolled in
a Part D plan and was not covered under any creditable prescription drug coverage.

Please see link for more info on the Late Enrollment Penalty imposed by Medicare and what you should do to appeal the decision. http://mymedicarecommunity.org/attachment.php?attachmentid=50&d=1185890053

When I used Humana, I had to fight them on almost every claim. They still owe me $300 for one but will not pay because my company dropped them, even though the claim was complete and they said I will receive a check soon. I would call and the response was "The check is still processing."
As soon as my company dropped them the response was "You are no longer with Humana so we owe you nothing."

I have also gone through the "We did not receive it" scenarios and the "we will not cover that drug because there is a cheaper one" even though the cheaper drug had already been tried and does not work.

Even my doctor said Humana is a bad choice.

I have worked for my company for years and had a different insurance company every 1-2 years. I have never had a problem with any of the others. I do not have a problem with the company I have now.
I am glad to have a good insurance company again. I hope you can find another.

There is a review process, my friend, because doctors have a nasty habit of initially perscribing the most expensive drug or treatment for the sole fact that they get more money by doing that. This rips off Humana, and indirectly, the patients because this causes premiums to go up. Of course Humana is going to want to have you try cheaper stuff first, that's only common sense. If you ran Humana, I can guarantee you would have the same policy in effect. Try to look at it from Humana's perspective and I'm sure you'll agree. Trust me, there is no hidden agenda at Humana. I don't work for companies like that.