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Egg
03-25-2004, 05:29 AM
I've posted before about this, but I have another question, and some info. to pass along.
My insurance co. denied authorization for Enbrel. My derm. doesn't really seem to care and doesn't seem to want to appeal it. I'm going to keep trying though, and I even have an appt. with another derm.
Anyway, I talked to a rep. from NPF, and she said that a lot of insurance co's. require that you first be tried on a systemic before they approve a biologic. Has anyone else had this problem? I really do not want to start MTX, and something tells me that there has to be another way around this. Any suggestions?
On a positive note, I asked the NPF rep. if she had any idea if and when Enbrel will be approved for P. She said that she can't give out any specific info. but she did say that it will be approved very, very soon! That sounds like good news. Hell, my insurance co. has never even heard of Raptiva!

chaimFL
03-25-2004, 05:53 AM
A lot of insurance companies haven't heard of the new biologics. Generaaly they don't until requests for approval start rolling in. When amevive was approved the makers of the drug had a department set up to haggle with the insurance companies.

You should call your insurance company and see exactly why you were denied for enbrel. If it was because they require the use of systemics first, then there are options to fight that, but if it was because the drug is not yet approved for P, then you will need a doctor to fight for medical neccessity.

Egg
04-07-2004, 05:41 AM
I just found out that my insurance company approved my appeal! I take my first shot tomorrow. I'm really hoping I have some success with this, because nothing else I've tried has helped. Thanks to everyone who replied and said I should contact NPF and Enliven. I don't think I would have been approved without their help. They were really great to deal with.

tphillips
04-07-2004, 07:01 AM
Egg:

Good luck with Enbrel. I wish you much success with it.

T

makeitgoaway
04-07-2004, 08:55 AM
That is great news.

Here is a link to some recent conversation on Enbrel:

http://www.psoriasis.org/forum/showthread.php?threadid=7884