Insurance Co.'s and Enbrel

[lil]

[:confused: Hello Everyone,
I am conducting a survey for private use, on those insurance companies which will pay for Enbrel either in whole or in part.

Currently I have a Blue Cross Blue Sheild PPO which is paying for it 100% (15$ copay). I have some crap going down in my life at present which may or may not cause me to lose my insurance.
This is the reason for my survey. If I have to enroll in a different insurance plan, I would love to know which of those out there are willing to pay for the medicine which has literally changed my life.

Please answer back with your company's name and how much they help you out. THANK YOU SO MUCH

lil

[sindye]

When I became disabled and could not work I lost all medical ins. Since I could not afford any insurance my Dr. suggested I apply for state medical and I did.
I was approved but here is the strange thing,
they would not pay for MTX, at $900.00 month, but with prior approval they are paying for Enbrel, at $1400.00 month!! How stupid are these people who decided what is covered and what is not???? When I was on MTX they paid for all my lab work every month but not the meds. Paying for the meds and the lab work still would of been cheaper then the Enbrel! I am not complaining because I really have high hopes for the Enbrel but I just thought it is really stupid what the state will pay for and what they will not!

[fleiscka]

My primary is Blue Choice. IVP care is the Pharmicutical company that order's the Enbrel for me and ships it to me Fed Ex. When my Dr. called them IVP called me back and said they would go with my secondary insurance. My primary would make me come up with the first $2000. Then they would cover the rest 100%. Well my secondary covers all. I just pay a $10 copay. My secondary is Healthlink. Now my derm just asked them to pay for double the dose of Enbrel and they O.K.d. Got my shipment this morning.

[luvwinnie]

Methotrexate for $900?? Per month? Methotrexate is an inexpensive drug...are you sure?

[cmorron]

I am also covered under Anthem PPO. My copay is $30/month. I was ready for a battle with them, but they agreed to cover it right away!

[lil]

I appreciate the response to my ? so far. I hope that you all have as much luck with the Enbrel as I have. The PA as well as the P has been much improved.
Good Health,
lil

[makeitgoaway]

Keep in mind that many companies operate independently from state to state. So if you have Blue Cross of MA and they approve it, it does not necessarily mean Blue Cross of NY would.

With that said, I had Blue Cross of MA approve me with no questions asked, just a $15 co-pay. I had to switch insurance with a job change and now have Aetna. They also approved me with no questions asked. As long as I use their mail order pharm., there is $0 co-pay.

Good luck!

[lil]

Hey Steve,

I can't believe my eyes. I use to have Aetna and EVERYTHING was a big fight with them. Perhaps some good changes have been made since I was a subscriber. Good news for sure.

I'm glad that you have had success with Aetna and Enbrel. Thanks for responding.
lil

[sindye]

luvwinnie,
I am sure about the cost of MTX at my pharmacy because I have paid it for a long time. My pharmacist told me it would cost almost half if I had insurance! Does not make any sense to me!!

[liz]

Sindye,

You should call around for different prices for the methotrexate my friend, as you are paying way too much.

My pills were over $2.00 each (which IS expensive per pill), but when you take 6 or 7 or 8 a week, that doesn't add up to $900.00 a month.

Call all your local stores, and look into mail order. I know you can get this cheaper.

Good luck,

I'm on hold waiting to hear if my ConnectiCare is going to accept paying for my Enbrel. Keeping my fingers crossed.

[Alilou]

Keep in mind that most insurance that is obtained outside a job will not cover pre existing conditions. I know this because I am Diabetic and cannot get private insurance.

[rjw123]

I learned yesterday the United Health Care approved my Enbrel, it took just over three weeks. It looks like my co-pay will be thirty dollars a month.

$900!!!!! I am on injectable Methotrexate and I get two 40mg vials (enough for a month) for $9.99. United Heath Care won't even cover it as it is so cheap!

[bgaviator]

I have United Health Care for two more weeks and I only pay $30/month for Enbrel.....but now I'm going to be on Anthem, and my co-pay jumps to $60/months. It sucks. I'm thinking about going off this stuff actually.....I've been on it for 3 months and I'm not that impressed especially for how much it is costing me. MTX was so much cheaper and worked fast.....and once I would get clear on MTX I would stay clear for a couple months without needing to keep taking the pills. I don't know what to think about MTX.....two of my derms have said I'm too young (27) to go on MTX cause I will do damage to my liver....but some other derms have no problem putting people on it. I don't know what to think about all this anymore.

[AnnieB]

I am self-employed so I have Oxford through a group plan (professional organization). The premium is expensive but they did approve Humira easily. $50 copay a month. BTW, the thing with "pre-existing conditions" is that you run into trouble if there is a gap in your insurance coverage. So it is really important to always have some kind of coverage--even if it has a high deductible and etc. It is WAY harder for the insurance to point to the pre-existing condition clause if you have had continuous coverage up until starting the new plan. I don't know all the specifics but I believe this is true in most cases...

[KDDM]

Hi!
I am in the process of starting Enbrel. At first I was denied but my derm appealed and just found out it was accepted! Yey! I live in NY and have Oxford for insurance. I believe my copay will be approx $100/month for the injections. Not terrible but definately hurts the pocket!

[web63]

I am with United Health Care.
I have a $50.00 copay for double doses of Enbrel.
I am now swtiching to Humira.
My Rheumatologist gave me a card along with the Humira kit, and I only pay 1 penny.
My insurance company charges the $50.00 copay, but the company that makes Humira sponsers this card, and they pick up the copay.
About the MTX my insurance does not cover MTX at all, and I pay $28.00/month for the injectable MTX.

[luvwinnie]

I have Aetna and pay $35 per month.

[in2theocean]

Hi,

I just started Enbrel on Wednesday. So far so good. No side effects or injections sight reactions. And, the best news is, I can wiggle my toes and make a fist with my left hand. All after one dose!!!! Don't know if it works that fast or I just "willed" it to happen.

I am on United Healthcare. My rhemy's nurse actually called the insurance company for me (she is WONDERFUL). They approved it with a $40 a month co-pay. The nurse also gave me an Enbrel kit (she said since I was with United Healthcare, I qualified for the kit). In the kit was an application for Enbrel QuickAssist. I received a card from QuickAssist which I give to the pharamist and my co-pay is covered for the first 6 months of injections. If you haven't heard of Enbrel QuickAssist, it's something I suggest you look into.

Good luck to you. I hope all goes well and you are able to get on Enbrel.

Shelley

[shyjade]

I have Prairie States insurance (in Wisconsin) and the only injection prescriptions they cover are insulin. So unless something has changed recently, I'm out of luck.

[RichJ]

hi shyjade,
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 night all

richard

[MikeK]

I have Prairie States insurance (in Wisconsin) and the only injection prescriptions they cover are insulin. So unless something has changed recently, I'm out of luck.

Hi Shyjade,

I don't think that we've met, so let me take this opportunity to welcome you to the Board. :cool: Nice to meet you. I'm sorry to hear that your insurance company may not cover Enbrel. :( I'm going to give you a link to a thread that was started by Lesley. (Momtotwogirls). She took the time to post the links and information about some assistance programs that she came across. I added the links and information to programs that people have either told me about or that have been discussed here on the board. There's even a link to a very helpful post from NPF staffer Alyssa Brown that gives the links to the assistance programs that the NPF knows about. We don't know very about most of these programs; it still can't hurt to get in touch with them. Here's a link to Leslie's thread: http://www.psoriasis.org/forum/showthread.php?t=12379.

Several people who post here have gotten assistance from a program called www.needymeds.com. (Miranda (LadyFraser) was able to get Enbrel for free thanks to a program called www.needymeds.com. (It sounds like a scam site, doesn't it?) She was able to qualify even though her husband was transitioning from being self-employed (with no insurance) to working for the government (with excellent benefits). She discusses her experience in this thread (circa 2004): http://www.psoriasis.org/forum/showthread.php?t=3979. Links to her story can also be found in Leslie's thread.) Other people have gotten helped from Enbrel's assistance program, which is called the ENcourage Foundation (www.encouragefoundation.com). (I believe that the ENcourage Foundation may have some income restrictions. It still can't hurt to get in touch with them.) Here's the links to some previous discussions about the ENcourage Foundation: http://www.psoriasis.org/forum/showthread.php?t=23298&highlight=ENcourage+Foundation;

http://www.psoriasis.org/forum/showthread.php?t=23020&highlight=ENcourage+Foundation.

As I mentioned, in Leslie's thread, I read in the Wall Street Journal, that a woman who was an assistant manager for a major retailer was able to get help from a program called Patient Services Incorporated or PSI. Unfortunately, PSI states on their website that because of funding issues, they can't provide assistance for psoriasis and several other diseases and conditions. That being said, it still can't hurt to check them out. Here's a link to their website: http://www.uneedpsi.org/eligibility.cfm.

I hope this helps.

Mike

[luvwinnie]

With Aetna I pay $30 per month...oops, thought this was a new thread.

[Estheticianmagician]

http://www.walgreens.com/library/finddrug/druginfo1.jsp?particularDrug=Methotrexate&id=13755

I've never been on methotrexate, but I looked it up at walgreens.com out of curiosity and it does seem pretty cheap - 72 2.5MG pills are $87.49 cents, though I don't know how much people take for p. 24 pills that are 2.5 mg cost $33.19

For my insurance I have Blue cross blue shield. Since I'm in a high risk category (because of my manic depression) ICHP (illinois comprehensive health plan) was the only insurance that wouldn't turn me down, because they are strictly for people in high risk groups that got turned down from everyone else. After I turned 18 and was not a college student, I didn't have coverage from my dad's insurance any more, so that's what I had to do because I didn't get any insurance through work.
My yearly deductable is $1000 and the monthly premium, I think it's called, is 300 a month. With my co-payments, a 60g tube of taclonex was $72, 100g of olux foam was $42 more or less, they cover %80 of my narrowband UVB. I don't know if all blue cross blue shield is that bad, but I don't think it's good, though it pays for itself.

Oh, and I almost forgot - they wouldn't cover my allergy test AT ALL. The one where they stick all those needles in your skin to see if you have outdoor allergys or food allergys. nice people.

[cdmason11]

[:confused: Hello Everyone,
I am conducting a survey for private use, on those insurance companies which will pay for Enbrel either in whole or in part.

Currently I have a Blue Cross Blue Sheild PPO which is paying for it 100% (15$ copay). I have some crap going down in my life at present which may or may not cause me to lose my insurance.
This is the reason for my survey. If I have to enroll in a different insurance plan, I would love to know which of those out there are willing to pay for the medicine which has literally changed my life.

Please answer back with your company's name and how much they help you out. THANK YOU SO MUCH

lil

My husband works for Tyson Foods. I pay 18.00 copay/month for my Enbrel. I teach school but am not enrolled in the insurance plan as the Tyson insurance cost much less.

[RichJ]

hi cdmason11,
welcome to the p family. you will meet some of the wonderful poeple on here and will find alot of great info. welcome and nice to meet you

have a good night all

richard

[tymbersmom]

Just started enbrel today.Went to the derm last thursday and today is tuesday so it didn't take long at all! I have Tri Care by the way

[tymbersmom]

Forgot to add that my copay is 9.00!

[dreitz]

I was just laid off a couple of months ago and cobra sent me a letter stating that you should not go with out insurance for 63 days or longer othewise that can affect your coverage.

debbie

[AnnieB]

If you have a "break in coverage" then when you try to get new insurance they can refuse to cover a "pre-existing condition". So it is best to always have some kind of coverage even if it is minimal (high deductible plan that is mostly for emergencies, for example.)

[KellyPSA]

I have Horizon Medicare HMO Advantage plan in NJ. This has a Medicare D plan. They will pay for Enbrel if it is pre-approved and if I can pay a 25% co-pay. I am on SS disability, so my income is very limited. I have also PAAD Pharmeceutic
Assistance for the Aged and Disabled and they cover all but 5 dollars for the Enbrel.

This may sound easy, but its not. The Medicare D part forces me to deal with a mail order pharmacy called Caremark. For each of the first six months of this year I needed to get a monthly pre-approval. Each cost me a two week delay and my symptoms of course, got worse. Finally I got a six months pre-approval. I am trying not to be negative, but I am really worried about the six months review.


Caremark tells you to call two weeks before you need your new supply. Following that directive, I was scheduled for a delivery every day for the two weeks, and each day I would be told I had ordered the drug too early and it wouldn't be coming after all. So I said to them, if I know that you can mail it only one week in advance, why am I dealing with the two weeks of scheduled and cancelled deliveries.

When I had a State Health benefits plan ( I worked for State of NJ) I paid my copay and got the drugs at Walgreens.

[Love2Live]

Has anyone had any experiences with Blue Cross Blue Shield HMO? I currently have the PPO and I believe Enbrel will just cost me either the $20 or $40 co-pay per month. I have to start paying for Cobra so my cost is jumping quite a bit. I plan to keep the PPO or myself and have the rest of my family switch to the HMO (which my husband's job offers). It would save me $300 a month if I switched over to the HMO. I'm just scared they won't pay for the meds I need.

[mikealex80]

My medical is United but my prescription coverage is with Aetna. Although, I've never been on Enbrel I checked on the prices in case I wasn't able to get the approval for Remicade. If I go to the pharmacy it is $20 however if I use the mail order it is $0. I'm not sure if I would have to fight for approval or not when I called they said it was covered under my plan. Also my remicade is $15 per infusion. There was no problem with approval and United even told me there was no need for preaproval they cover it no questions asked. I have an EPO with United.