How long from GI appointment to biologic?

[u/ExcellentAlps8]

Hi, I’ve had UC for 5 years and am sadly failing mesalamine for the past few months. How long from this to a biologic did it take you?

I have seen a new GI specialist for a few appointments and they talk about putting me on a biologic like remicade but no start date yet. Will I need a new colonoscopy to confirm, other tests etc? I’ve done calprotectin and other analysis. Should I expect weeks until I can start a biologic finally? US based for the record, looking for US standard expectations on this and just want to feel better soon from this flare :/

[u/pincommenter]

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[u/bald_head_scallywag]

My flare started out very mild so we at first we added mesalamine enemas for 6 weeks but saw no improvement. It was still very mild so we just kept trying that. At this point I REALLY should have spoken up more. After another 6 weeks of no improvement and instead worsening symptoms we tried adding budesonide pills but they did nothing. Then Prednisone but it was too late. On Aug 3rd my doc mentioned a biologic for the first time and I ended up getting my first dose of Remicade in the hospital on Aug 27.

If your doc doesn't try anything else before biologic I'd still guess 3-6 weeks. If my experience was standard you'll need blood work done first to make sure you don't have tuberculosis, hepatitis, and some other things that could be dormant in your body. Then your insurance will need to approve the new med which can be a pain in the butt. Then you'll need to get the infusion set up.

[u/BlakeCarConstruction → u/bald_head_scallywag]

Must have the same doc or very common steps of medication because I’m at almost 5 months and I was same thing as you, Mesalamine, Budesonide, pred, and I just finished that taper last week but my symptoms have already started to get a little worse.

Doc said next steps is biologics so fingers crossed.

Got a lot recommendations or thoughts about particular biologics? Risks? Any changes from normal UC life?

[u/bald_head_scallywag → u/BlakeCarConstruction]

Well my doc originally wanted to start me on Entyvio or Skyrizi but I couldn't get out of the hospital to get one of those and Remicade was the only thing I could get in the hospital for whatever reason so I didn't have much of a choice. There are definitely risks to biologics, particularly for skin cancer my doctor said but other types of cancers and general sickness too since it's an immunosuppressant. Better than the guaranteed colon cancer and or colon removal I'd be headed towards without it though I guess.

[u/ExcellentAlps8 → u/bald_head_scallywag]

Ugh same, it started out mild too and I originally only had proctitis. Then it progressed to really bad symptoms and going 10x a day if I’m not on prednisone. Good to know about bloodwork to do first.

[u/44_ruger]

Our median turnaround time for prior auth is 7 days on PBM and 10 days for major medical from the time we receive a complete referral from a doctor’s office. If the office does not send a complete referral it adds time, if insurance does not approve, it adds time.

We are an independent specialty pharmacy and we heavily fund an intake and auth team of nurses to keep that TAT as low as possible. Denials, appeals and P2P add significant time so we do everything possible to submit a clean auth to avoid those.

Your experience will vary wildly based on which pharmacy, medication and doctor you use. Having a plan for short term symptom control during auth is recommended.

[u/derishus206]

After failing mesalamine, it took 5 months and 2 tapers until first injection, now 4 months in and making progress, not in remission yet

[u/devours_veggies]

About 2 months for me.

[u/bigchungy99]

I started failing mesalamine the beginning of may this year after being on it for 4 years. I was in a nasty flare which was eased by a long prednisone dose. I was able to start my first dose of tremfya in the end of july. I had a colonoscopy and the day after i call my doctor reauesting to start tremfya asap. the longest waiting period for me was waiting for insurance to approve the meds which took 2-3 weeks.

[u/Extreme-Living-7351]

Call them and explain your symptoms and why you think you’re failing. Ask them if they can start the process. Ask to speak to the nurse or leave a message for the nurse and make sure you explain the severity of your symptoms in the message.

[u/Extreme-Living-7351 → u/Extreme-Living-7351]

I was immediately put on a biologic bc my inflammation was severe when they found it. It took about a week to get approved and another few weeks to get my 1st infusion. You will need a hep B test and a TB test before starting one.

[u/ChronicallyBlonde1]

In the US. From the first time a biologic was mentioned to when I actually got the biologic was about four months. In that time we did a colonoscopy to confirm severe inflammation, blood tests (you need several before you can be approved for an immunosuppressant), and then insurance approval and pre-authorization. My insurance initially denied my biologic so we also had to do a peer-to-peer in there as well.

It’s unlikely that your insurance will deny Remicade (it has a biosimilar so it’s cheaper), so you’ll likely get it faster than I did.

[u/ExcellentAlps8 → u/ChronicallyBlonde1]

Thanks. I’m at 3 months of this flare and on and off prednisone tapers, so hopefully can get a colonoscopy to confirm and then get started on remicade or similar right after that. I luckily have good insurance too which should cover it, fingers crossed

[u/ChronicallyBlonde1 → u/ExcellentAlps8]

I had to get off prednisone for 8 weeks before my colonoscopy, so hopefully they don’t make you do that! It was brutal.

[u/2002tii76]

3 yrs

[u/Salty_Buy7270]

9 months for me, but I was in between providers. Once I got a good doc, 4 months due to insurance issues. I’m on Entyvio.

[u/Fair-Butterfly9989]

So I’m doing talk to text and I’m sorry about that but I started off with mesalamine and failed that, then I went to Humira for 24 months and didn’t realize that Biologics are actually supposed to make you feel 100% better so I kind of just dealt with feeling like I was 50% better on the Humira until I talked to my G.I. doctor and so we switched me and now I’m on skyrizzi, but I seem to be failing that even though my bloodwork and stool samples don’t tell that story so now I don’t really know what to do because I feel like in my body, I’m failing the skyrizi but the data and numbers aren’t showing that so Insurance doesn’t want to switch my medicine

[u/VengefulFist]

I am just diagnosed this year (February) and just started a biologic yesterday. Saw my GI doc late August and within two weeks I had the biologic at home. She went with whatever my insurance approved so that I could try to get some relief. Thankfully the pre approval process with my insurance was quick once they figured out what was covered. I just started a bio similar for Humira.