INSURANCE (enbrel)

[KIMMY]

Anyone out there who has had enbrel approved by their insurance carrier for the treatment of P??? I may soon be registering to use it , but need to know if its worth getting my hopes up, because i don't know if humana will pay for it. or if its an even approved drug for use for P. Please reply to this thread. thanks

[jbureksr]

Kimmy: I believe Enbrel has "Not" been approved by the FDA for treating "P" to date. It has been approved for R.A. and P.A. and shown to clear "P" in many instances. My memory tells me it is in the trial stage to treat "P". NPF should have this information posted on this website.;) ;) :)

[ladyandy]

there are clinical trials ongoing for that application and I believe that application has been submitted to the FDA for approval. You'll hear about it here once the approval is announced.

However, it has already been approved for psoriatic arthritis, so if you have PA as well as psoriasis of the skin, you should be able to get it.

Here is the page on this website that has more specific information about Enbrel: http://www.psoriasis.org/research/biologics/enbrel.php

Good luck!

[sapphire4373]

Kimmy,
I can tell you from personal experience. NO Insurance will not cover Enbrel for psoraisis only. I was denied and the denial was upheld after my appeal. And believe me I fought tooth and nail.
I was however just diagnosed with PA of my spine, so I am now in the process of trying again for Enbrel.
Oh I should add, my case was with Blue Cross Blue Shield. So I can't really say all Insurance companies won't approve it, but BC/BS won't. I know that isn't what you want to hear, but that is the fact of the matter. :(

[oakrai42]

I have been using Enbrel for 5 weeks, for P only (there was a possibility of PA, which has been confirmed NOT to be true). My Derm wrote a prescription for it for me, which I sent in and got Enbrel no problem (I was in the enrollment program just prior to the new plant opening).

How are insurance companies aware of what you're using it for anyway? For all they know it could be for PA, which it is approved for? As long as they cover/provide it, and you have a prescription, I wouldn't think that there'd be any questions coming from the insurance company as to why you are being prescribed it. I've never had my insurance company question why a doctor is prescribing me something (I have Cigna). They just pay for it ($30 out of my pocket for a 3 month supply of Enbrel). Maybe this is just with Cigna, I don't know.

[sapphire4373]

well in my case with Blue Cross, Enbrel is one of the meds that requires prior authorization. There fore they have to know the reason you need it.. It really sucks because so many meds are prescribed off label that they are never aware of, but I guess it is the cost of Enbrel that has some Insurane companies not wanting to cover it, if they don't have too :rolleyes:

[Amber22]

My insurance coverd it with no problem...and i havent been diagnosed with a for sure case of PA...I was so happy when i went to the pharmacy and there wasnt any questions asked...cause this is something that my doc has been waiting for for a while.....

[linda777]

I have PA and have been on Enbrel for 2 months it has helped some of my joint pain but my P has gotten worse! Since Enbrel I now how more skin problems.. anyone else experience this???