How do you get enbrel?

[wendysmiling]

Hi,

The ONLY arthritis meds covered by our insurance are NSAID's and MTX. Our gp told us it would take both our monthly salaries combined to pay for a 30 day supply of enbrel (jeez!)
The nsaid's don't work and I suppose the rhemy will give him MTX when we go in for our 1st appt. I don't see very often where people talk of good success w/ MTX.

Does anyone know how to go about making an insurance co pay for a med after you've tried all their "covered" meds?

Thanks,

[FlakeyMatt]

Yes Enbrel is pretty expensive MY understanding is without insurance a monthly suppoly of about 8 shots would cost roughly $1,000.00

If it is NOT on you pharma plan you can go about trying to get an exemption for coverage. You will need to contact your specific insurance company to see how this is done. Usually, it will resolve your complete medical history plus and an explanation from a physician on why the medication is the correct one for your physical problem.


Also, many drug manufacturers have learned that by acting as patient advocates they are doing themselves a favor. Therefore checkout www.enbrel.com and try contacting the company. They may have be able to lend a hand.

There are also several websites which assist patients in getting meds which they nomrally would not be able to afford. Sometimes this is thru government programs and sometimes this is thru programs the pharma companies set up to dispense medications for free. I need to check on something and I will post some links in a moment or so.


Good luck and keep us posted.

FlakeyMatt

One great site is right here under our noses. And that is our own advocacy board under resourses bove. Good luck. I am in the process of dealing with my insurance company's denial at the moment. Won't go down without a fight.

[MikeK]

Hi Wendy,

Sorry to hear about your battles with the insurance company. :( :mad: Annie is right, please give the NPF a call. Their insurance advocacy department is a great place to start. Here's link to their description of the services that they provide: http://www.psoriasis.org/medical/advocacy/ and here's their contact info:

National Psoriasis Foundation
6600 SW 92nd Ave., Suite 300
Portland, OR 97223-7195
Phone: 503.244.7404 OR 800.723.9166
Fax: 503.245-0626
E-mail: getinfo@psoriasis.org

Their regular business hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. Pacific Time.

The company that makes Enbrel also employs insurance specialists that tries to assist patients with enbrel related insurance issues. You can reach them by calling 1-888-4ENBREL (1-888-436-2735). Here's a link to a more complete description of the services that they provide: http://www.enbrel.com/enliven/enbrelenliven-insurance-help.jsp.

You also might want to try www.needymeds.com. It sounds like scam site, but several people who post here have been helped by it. Here's a link to a thread that has two www.needymeds.com success stories in it: http://www.psoriasis.org/forum/showthread.php?threadid=3979.

You can also try calling your state's insurance department or commissioner. You can find their contact information in your phone book. It also should be on your state's official website. You can find it by doing a google search. (I live in New Jersey and, normally, I would post a link to New Jersey's "official" website at this point -- just so that you'd have an idea of what to look for. Unfortunately, our official website seems to be down at the moment. :rolleyes: ). I'll try to remember to post the link when it comes back up.

Good luck. Hope this helps in some small way. Keep us posted.

Mike

[wendysmiling]

"You can also try calling your state's insurance department or commissioner. You can find their contact information in your phone book. It also should be on your state's official website."

Sorry but this really made me laugh. Our insurance commissioner is soon to be in jail for creating fraudulent companies. A couple of months ago he was busted for a DUI. I'm from Calif but now live in Oklahoma. This is the worst state in the nation as far as services available to the public. Calif has so much on the ball to help those that need it. If we could afford it, we'd move back there in a heartbeat. Thanks for all the info. We will look into it. You all are the best here!