How hard is it to get a Rx for Enbrel?

[femaletrouble]

Today at my appt. I brought up Enbrel and it was shrugged off, and I asked why and they said that I had to do a test for TB and fill out paperwork and apply, so I asked why didn't we do those things so I can get the ball rolling.

Then I was able to speak with the Dr. who was just doing his residency who the most helpful and I asked him if it was because I wasn't elligible and he said that wasn't the case. Then I asked if there are side effects that are serious risks and he said that wasn't the issue either, but rather that the insurance companies don't like to approve Enbrel because it is so costly.

Why are they being dodgey and giving me the runaround? Was it this difficult for other people to get it? What are my chances of Blue Cross Blue Shield not approving Enbrel? I don't understand this.

It's not like I haven't exhausted any other options, or that my psoriasis isn't affecting my daily life. Not to mention that I already have arthritis at age 22...

[chaimFL]

All you need to get a prescription for enbrel is a doctor to write it out like they do all other prescriptions. Once you have the prescription you can call your insurance company and ask them if they have a specific pharmacy for you to use. I know when I was on enbrel my insurance approved it (I had a $35 a month co-pay), but I had to use a specific mail order pharmacy.

[PJ66]

I didn't have any trouble. It was me that was dodging the dr. when he first mentioned me trying enbrel. It took months to convince myself that I should try it. I had blue cross/blue shield. I didn't have any trouble with getting the medicine. I could have went to the pharmacy or do the mail order. The mail order was only $75. for three months. It would have cost me $75. for 1 month at the pharmacy. You could call your insurance and ask if they cover this and how much of a co-pay you would have. I did this ahead of time just to see. They were very helpful.
Polly

[alli]

I'm just going to throw this thought out there.....it may have to do with your age. When I started on enbrel, I was in a clinical study. The doctor running the study said he would never use enbrel on women who were of child bearing age. I'm in my forties. In addition to taking the TB test, I had to prove that I used a ' medically approved' method of contraception and I took so many pregnancy tests that I started to giggle eveytime they handed me the urine cup.
Perhaps this is your doctor's mindset as well.

[grannyfranny]

My derm called my insurance while I was in his office and got it approved then.

[ouchyk]

Hi,

" Not to mention that I already have arthritis at age 22..."

I do hope your seeing a rheumatologist for your arthritis, I'm assuming your talking about PA. :( .

I had no problem at all getting Enbrel and later Humira ( off label at the time ) for my psoriatic arthritis. I don't have bc/bs, but didn't have a problem with my insurance with approval. My rheumys office had me pre-approved.

Good luck,
Karen

[LadyHawke9973]

When I was on Enbrel two years ago, I walked out of the derm's office with a scrip for it the same day he finally convinced me to try it. I'm on BCBS....they called in for the approval while I was sitting there, and I got the quote from the nurse, "never seen one come back so fast".

I see my derm again this afternoon. I'm hoping to walk out today with (if not Enbrel, then) comparable aggressive approaches in hand.

Talk to them again....pursue it if you're really interested.

[Maracel]

In response to difficulty getting a prescription for Enbrel. I tried it once for 2 months and the derm said, "you're not responding" and took me off. I thought you had to give it longer than 2 months! I went to light treatment, got no response, and suggested we try Enbrel again, and he had me do the blood tests - twice. Both times he said my liver function was slightly elevated, and hasn't gotten back to me since the last test (that was 4 months ago). My conclusion is that he's stalling. I belong to Kaiser, and I think they don't want to put their patients on such expensive medicine. He kind of made a big deal about how much it cost the first time. Unfortunately, I've pretty much tried everything else without much success. I've been dealing with p for the last 40 years - I'm 60 now, and psoriasis started when I was 20.

[oakrai42]

If your derm won't prescribe Enbrel when you ask for it, and doesn't present any educated reasoning other than insurance company woes, then it's time to find a new derm.

I went through 8 derms before I found the one that I've been with for 4 yrs now... and he's my own personal drug dealer. I tell him what I want to try and he does all he can to make it happen. He takes care of the insurance company issues, the paperwork, writing me scripts for whatever I want (topicals to coincide with biologics or systemics)... he's the best because he understands P and how difficult it is to treat, and that we are the ones who need to direct the treatment when we have so many options... I went through 2 derms that wouldn't give me cyclosporine saying it was a last option (I was 8% covered!)... I found the derm I'm with now and the first thing he said was "how about cyclosporine?".. I almost hugged him... I've used cyclo twice for a year at a time and was 100% clear the whole time... Those other derms can kiss my P-FREE WHITE A**!! :)... and no side effects or other issues, because my derm watched me closely and told me what to do and what not to do while on it.... Derms should be providing the medical support, supervision, and guidance... not making excuses and treating us as if P is something that can just be passed off...

I say get a new derm... there's lots out there, so jump around as much as you please.

Oh, and BCBS shouldn't be an issue. Whatever your plan is, it should have a prescription plan with 90 day mail order option... which is usually around $40-50 or so for the 3 months (prices vary... mine was $40... my script plan was under Caremark, through Cigna).

and if your derm said that you need a TB test for Enbrel, then really get rid of him... that's for Humira, not Enbrel... if he doesn't know the difference between the two drugs, he shouldn't be treating anyone.

-Steve

[femaletrouble]

Yeah, I thought it was kind of bizarre that nobody else on here had to do a test for TB...

I already decided to switch doctors, on to derm # 4, I guess statistically the more i try, the higher my odds of finally landing a good one will become...

[PJ Leary]

Hi fm,

Please allow me to tell you that it is standard procedure to have a TB tine test before on may begin a course of enbrel, that part at least is in fact true. It is simple, can be done and "read" ion any dr's office or clinic, and is inexpensive. If you have BC/BS, it will be covered.

I also have BC/BS, and used enbrel before it was approved for psoriasis skin disease under the pa diagnosis. I got pa at the age of 18, and I am now (29) in my 40's. While I do think you should consider a new derm, Karen is right that you should seek out a good rhuemy for the pa. You are young, and it is time to get a good idea of exactly what you are dealing with as far as the joints are concerned now.

Getting the enbrel approved was not difficult at all, nor was getting the dose doubled more than a year later. I did have to use their specialty pharmacy through the mail, or I had no coverage at all, but the coverage I did have was very good from the patient's perspective. You can call BC/BS yourself to inquire about your coverage before you even get the script.

In order to have unrestricted access to these medications it is going to be inplortant that these two official diagnoses, both p & pa, are clearly established as a part of your medical history.

Good luck finding a new derm. Post here if you want to let people know your location so that they might offer suggestions. Also, the Foundation maintains a listing of derms who treat psoriasis patients across the country.

Regards,

[femaletrouble]

I just made appointments with a new derm and a rheumatologist, and I found them by searching local doctors on the NPF site with Enbrel as the search criteria.

When I called to switch doctors (my old derm and my future derm both are through the Oregon Health and Sciences University), the receptionist kind of scoffed at me when I said that other people I had spoken with were able to get Enbrel faster and it didn't seem like such an elaborate process for them. She asked me if they went to Canada or something.

I mean, I don't want a doctor who will just prescribe me something on a whim, or not take the necessary precautions before making the decision, but failing to even do a substantial job of answering basic questions about the process of getting the medication is just as bad. i think.

[WillysRash]

It was not hard to get the Rx, its was hard/impossible to get BC to pay for it...they denied it and said I need to try UV light AND a systemic first, prior to enbrel. The light has worked wonders, though now the insurance company wont pay for more than 35 treatments/year....SOB's. So now I need to get a home unit, the Dr will on perscribe one that has a code after so many treatments for some reason....the insurance company will make me pay 25% plus a deductible for the 2500$ light box the Dr wants me to get....the insurance compant has one in network provider for a light box that is antiquated....great huh? My plan is to "go on" a systemic that has the potential to eat up my liver when I drink (I drink ...I admit it)....throw the pills away, tell the Dr it aint for me after a month...and then try to get the insurance company to pay for the enbrell......though the Dr said they have a mving target and what they wanted me go through prior to paying for enbrel may be different now...as in more restrictive. Blah....
Willy

[smudumba]

It was not hard for me to get it from AETNA. My derm, first started me off with UVB stating that it's easier for him to prescribe, and me to get Enbrel, if he shows the records that other treatments have been TRIED.
So, some derms know well how to get around those insurances. I would say try different derms. it may take a month or so before you get it approved by insurance. Good luck. Hope you'll get it, it's a wonder drug with minimul side effects.

[oakrai42]

Hi fm,

Please allow me to tell you that it is standard procedure to have a TB tine test before on may begin a course of enbrel, that part at least is in fact true. It is simple, can be done and "read" ion any dr's office or clinic, and is inexpensive. If you have BC/BS, it will be covered.


The NPF's information does not mention a TB test for Enbrel, but it does for Humira. I've been on Enbrel 3 separate times and a TB test was never done, nor was it ever mentioned as a concern or something to look for while on it. The moment I mentioned Humira, TB was required, both by my doctor and the pharmacy. They needed the results from my doctor and a verbal confirmation from me that I had it done.

Here's the NPF links:

http://www.psoriasis.org/treatment/psoriasis/biologics/enbrel.php

http://www.psoriasis.org/treatment/psoriasis/biologics/humira.php

TB is only mentioned in relation to Humira.

-Steve

[jdeldrid]

I had to get a TB test prior to starting Enbrel. In fact, the only hold up at the appointment I had today to learn how to shoot up was when they couldn't find the results and had to have them refaxed from my Internist.

Anyhow, what's the big deal with a TB test?

[oakrai42]

Anyhow, what's the big deal with a TB test?

The actual test is no big deal... but since Enbrel's been out I've never heard of this, even going on it three separate times with two different derms over a span of 2 years, and I didn't want to see false information going out to someone who is having struggles trying to get it due to an ignorant dermatologist. It is not a standard procedure to have it done in order to be prescribed it, unless things have changed in the past 3 months since my last script was sent in. If things have changed, then it hasn't been communicated to the masses properly.

-Steve

[strmchaser]

I had to get the TB test to, I was told it was required. Linda

[PJ66]

I had to get the TB test to, I was told it was required. Linda
Me too. That was over 18 weeks ago.
Polly

[ShadowThomas]

I had no problems getting, Enbrel with B/C. but I think my derm wrote a letter back in, July of 05 I just refused to take a needle back then. The only way I would take, Enbrel was if I was seen by a Rhuemy and if that DR. felt I should take, Enbrel, then I agreed to do it. Yes ! I am stubbern Lol. But that was the deal I made with my derm Lol.
My derm knew when my appointment was with the Rhuemy, so she had me take all the blood test and the TB. test and sent the results to my new Rhuemy.
Truthly, I did not think this Rhuemy would prescribe, Enbrel, but he did Lol.
I was lucky because when it came time to taught how to give myself the injections, I was shown by a Enbrel nurse that came to my derms office. :)
I had to go off, Enbrel as of the 26th of, Dec. on count of an infection, but will be back on, Enbrel this coming, Monday.
So far I have only had #11 injections and sadly I still have not seen any difference in either my P. or PA. :(
But I still remain hopefull :)

[SCCatman]

When my derm started talking about Embrel, he had his nurse give me the tb test shot then, and said call back if it turned red.
I think most derms require a tb test.
The problem is that TB is getting to be more ocmmono, and many people have been exposed, but the disese is latent. When embrel tunes down the immune system, the tb can take over and be a serious problem real fast.
I think Amgen, the makers of embrel recommend a tb test first.
it is cheap and easy, and if you have not had one in recent years, a good idea anyway.
A friend in Ca. took the tb test and it came back positive, he had no idea where he got from.
Dennis

[oakrai42]

When my derm started talking about Embrel, he had his nurse give me the tb test shot then, and said call back if it turned red.
I think most derms require a tb test.

FYI...
From what I understand from my dr and from numerous online resources, it's not if the area where the test was administered is red, but rather if it raises up from the surface of the skin, and if there's a 'bump' to the touch. Also, it is important not to irritate the area with moisturizers or anything like that (including touching it yourself) as it can cause the test to be inaccurate.

My TB test result was negative, even though the area was red. I think it's more the combination of red & swollen that dictates a positive result.

-Steve

[arent18]

Just a little info on Piece of $hit, worthless Kaiser and my situation....


I was diagnosed with P at age 10. Not too bad, elbows and knees, but for a kid in Elementary school who lives in sunny San Diego and wears short sleeve shirts and shorts all day, a little worse. Kaiser gave me coal tars and all the basic "first step" medications.

I used those stinky non-helping tars and ointments for about 6 years.

At age 15 I hit puberty (late bloomer) and my P got worse. Elbows, knees, scalp, knuckles, back, and chest. Kaiser insisted that I wait 6-8 weeks to see a derm. Again, inreased the tars and ointments.

My senior year in High School I had a huge breakout. I was now 60% covered. I played football and baseball and was "bashed" by my teammates in the locker room, but I had "thick skin" and took it.

After I graduated I began educating myself about all the new treatments and everytime I brought them up to my Kaiser derm., they were shot down. At this point I was on ointments and light treatments. No success, again.

At age 25, I I was 85% covered and a little depresses and willing to try anything. I went to a "study" for a medication and it didin't help. I again asked for biologicals like Raptiva and was shot down. My derm wanted to put me on pills that may affect my liver and make me sensitive to the sun, but I couldn't do that because I am a Law enforcement officer and work outdoors. My derm. told me to buy baby oil and have oil on my skin 24/7. I thought that was rediculous, but I tried it. All I got was sunburn and irritated.

At age 26 I got a call from the same office that administered the previous "study" and was told they had a new treatment for P that was already approved for Arthritis and they were going to start perscribing it for P. I jumped on the opportunity.

I was given Enbrel and within 8 weeks I went from 85% to less than 3%. When the study was complete I went back to Kaiser and showed my derm. the great progress and asked him to perscribe Enbrel. He sai NO!!!!! He said that it was too expensive, and it was not on Kaiser's P treatment list. I could'nt believe that after all this time, my derm who has seen me suffer for years and years was telling me this. He said I could appeal to the Kaiser board of medications, so I did.

I waited 6 weeks for this meeting. My P started to come back so I was freaking out. I met with the board. They had my file, which was about 80 pages long and listened to my plead. They smiled at me and sai they would let me know.

2 weeks later I got a letter from Kaiser saying that in my derms opinion, I was not a candidate for Enbrel, and there was little or no proof that I even had psoriasis!!! I was angry and felt helpless. I felt betrayed.

Luckily for me, my Agency had an "open season" for insurance companies coming up. I did my homework and switched to BC/BS. Within a month I was back on Enbrel.

It's been almost 2 years and I'm still on Enbrel and still less that 3%

KAISER DOESN'T CARE ABOUT PSORIASIS PATIENTS. THEY ARE A SCAM!!!!
EVERYTIME I SEE THIER ADS I WANT TO PUKE.

Just my 2 cents, or maybe a little more.

On a side note, Enbrel is using me in their upcoming ads. You can see some of my pictures from my photo shoot at my myspace page. The address is right below my name.

[Kat1]

I have BC/BS and it was no problem to get on Enbrel. My derm did a TB test and faxed an RX to Medco Pharm {BC Pharm} for a three mos supply. I paid a $20 co pay for the 3 month supply. I always use the Medco Pharm because I can get a three month supply of my Meds at a time for the same $20 co pay I would pay for a 1 mo supply from a private pharmacy.
Be Blessed. kathy