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View Full Version : Too much to complain about...


NiKsDaEd
10-22-2007, 06:33 PM
I think I need to rant a little, but I do need some opinions too...

I'm so fed up with my derm, problem is she is like the only one in the town were I live. I've been "seeing" her for just over a year and in all that time the DR. has never looked at my Psoriasis, I've been pretty much writing my own perscriptions (in a sense). My last visit to this derm, if paid out of pocket, would have cost $160- I pay a $50 copay and the insurance picks up the rest. Want to know what really makes me mad about that? The Derm was in my room less then 5 minutes, and aparently never heard a word I said.

My current insurance had reached it's perscription cap so there is no more money for Enbrel. My last shot was near the end of June which means my P is raging out of control now. I recently recieved new insurance from my place of work and this company needed preauthouization to fill an Enbrel script. I gave the nurse (cause the doc was off to see other patients for $40/minute) all my insurance information and phone numbers to get a pre-auth for Enbrel. For grins and giggles I told them if the Enbrel couldn't be authorized then try for Raptiva (which had come up in the short conversation with the Derm). After I didn't hear anything for a week I call the office and was told that the Derm had put it on hold for some reason and no one ever called for the pre-auth for Enbrel. I told her to unhold it and call the insurance co and take care of it. She said she would call me back later that week and let me know how they make out.

Heard nothing for a week so I called back today and spoke to a different person. I restated my story and this person said they would check into it and call me back later today. I explained I would not be able to answer my phone but she could leave a message on what she could find out. After work I listened to my message... She said I didn't need a pre-authorization for Raptiva and that they (my insurance co) should be calling me later that day to arrange delivery. There was no mention of the Enbrel at all.

I've been off and on with Enbrel over the last two years or more. It's the only biologic I've ever taken because it works for me. Aparently my Derm gets bookoo kick-backs for prescribing Raptiva, therefore she is unwilling to help me get Enbrel.

So, I know finding a new Derm is one of my next steps(which finding one isn't the problem, it's getting to them since they are almost an hour away), but I really need to know from people who have used both Raptiva and Enbrel, what's the deal? Which worked better? Side effects differences between the two? Cost? Bless you if you bothered to read this far... I just need some answers before I commit to Raptiva.

Thanks for reading.

MikeK
10-22-2007, 08:53 PM
Hi NiKsDaEd,

Welcome to the board. :cool: Nice to meet you.

I'm sorry that your having both dermatologist and insurance issues. :(

Even though it's going to mean travelling over an hour each way, I agree it's time for you to start seeing another derm.

In the mean time, please give Enliven Services (Enbrel's Customer Assistance Hotline) a call. According to their website, they have "insurance specialists" who offer:

Assistance with the prior authorization process
Assistance with the appeals process for benefits that may be needed
Follow-up on the status of your claims
Assistance with yearly insurance recertifications
Referrals to specialty pharmacy services
Benefit-education materialsSource: http://www.enbrel.com/psoriatic-arthritis/insurance-help.jsp.

Their phone number is: 1-888-4ENBREL (1-888-436-2735).

You also might want to give the NPF a call. They have an Insurance Advoacy Service that goes to bat for people who are having insurance issues. Here's a link to a discription of the services that they provide: http://www.psoriasis.org/advocacy/assistance/insurance/index.php and here's a link to their contact information: http://www.psoriasis.org/contact/.

You asked about Raptiva. Raptiva has a very odd track record here. First, Raptiva is notorious for causing psoriasis to flare horribly if you have to stop taking Raptiva for any reason. For that reason, it's important that Raptiva users have a backup treatment plan in place should they have to stop using it. Second, some people do very well on Raptiva. For example, Diana (cordiod) has been chronicling her very successful journey with Raptiva in this thread: http://www.psoriasis.org/forum/showthread.php?t=16374. SuzanneT who has pustular psoriasis (blisters) on her hands and feet is also pleased with the results that she's seeing from Raptiva: http://www.psoriasis.org/forum/showthread.php?t=26553. Pipegirl is also very pleased with the results that she's gotten from Raptiva (please read the entire thread): http://www.psoriasis.org/forum/showthread.php?p=302322&highlight=avatar#post302322. Unfortunately, not everyone is as luck as Diana, Suzanne and Piper. Some people have had horrible experiences with Raptiva. You can read about some of their experiences by following all of the links in this thread: http://www.psoriasis.org/forum/showthread.php?t=22358.

I hope this helps.

Good luck.

Keep us posted.

Let us know if you have any other questions and please don't be a stranger.

Mike

RichJ
10-23-2007, 01:40 AM
hi niksdaed,
sorry i can't help much but welcome to the p family. you have met some of the wonderful people on here and will find alot of great info. welcome and nice to meet you.

have a good day all

richard