Hi all,
I am wondering if anyone has had trouble getting approved for Enbrel. Specifically with BCBS of Alabama. I had been using Enbrel and our company was bought out and we were forced into BCBS of Alabama. They have denied the claim asking for traditional perscriptions for 6 months. My dermatologist has been trying to talk with a supervisor there to find out what exactly they are looking for as I have had psoriasis for 20 years and have used just about everything there is with no luck except for the Enbrel. I also have an Enbrel representative trying to get a hold of someone but they leave them on hold and never return the phone calls. I have submitted a complaint to the Insurance Commissioner recently as this has been going on for 5 months.
I now have reason to believe that they may not be approving the Enbrel for a reason totally unrelated to this issue. So first I am curious - since the first perscription with the previous insurance company was approved right away - does anyone know of anyone who has been approved by BCBS of Alabama and/or what other avenues I have to turning their approval around.
Thank you,
Kristi

:mad: I am sorry to hear of what you are going through. I do not have that insurance but I have just gone through that situation myself.
Every insurance company is different and where I work we went to one that did not cover my enbrel. I fought with the insurance co. for 3 months and I am not getting at a reduced co-pay. I will have to pay 25% of the cost for each scrip. They classify enbrel as level 4 med, as is all the meds for P, so I am out of luck for now.
I would call you insurance co and get a hold of the pharmacy div. and find out why you are not covered or what you are covered for. They may have you at a level 4 also.
My insuance co. told me because it is a new medicine is is very expensive.
If you are not working or earn only 30.000.00 a year you could call 1 800 enbrel. I also tried this and I did not qualify. I also tried The VA as I have a VA medical card and they also turned me down. These are tough times and they just don,t understand.
I hope you get your your situation resolved and I wish I could be of more help.

Hi,
Sorry to hear about the issues you are having about approval for your medicene. The National Psoriasis Foundation has an area within the foundation that will help individuals with their problems about getting coverage. Check out the front page of this site and their will be a place for insurance advocacy. I would bring it to their attention and see how they can help.
Good luck
Sandy

Hi Kristi,
Welcome to the Board! :cool: Nice to meet you. I'm sorry that you're having insurance issues. As Sandy mentioned, the NPF has an insurance advocacy service that goes to bat for people who are having insurance issues. Here's a link to their description of their service: . And, here's a link to their contact information: , Give them a call. Hopefully, they'll be able to help you win you battle with your insurance company.
Mike

:mad: I am sorry to hear of what you are going through. I do not have that insurance but I have just gone through that situation myself.
Every insurance company is different and where I work we went to one that did not cover my enbrel. I fought with the insurance co. for 3 months and I am not getting at a reduced co-pay. I will have to pay 25% of the cost for each scrip. They classify enbrel as level 4 med, as is all the meds for P, so I am out of luck for now.
I would call you insurance co and get a hold of the pharmacy div. and find out why you are not covered or what you are covered for. They may have you at a level 4 also.
My insuance co. told me because it is a new medicine is is very expensive.
If you are not working or earn only 30.000.00 a year you could call 1 800 enbrel. I also tried this and I did not qualify. I also tried The VA as I have a VA medical card and they also turned me down. These are tough times and they just don,t understand.
I hope you get your your situation resolved and I wish I could be of more help. Hi Baka83,
I'm sorry to hear that you are also having insurance issues. :( I'm not sure if they can help in your situation, but it still can't hurt to give the NPF a call and see if there is something that they can do.
A couple of years ago, during a discussion of high Enbrel co-payments (), a poster who came and went very quickly from the Board, mentioned an assistance program, called Patient Services Incorporated or PSI. According to their website, PSI is a non-profit organization primarily dedicated to providing health insurance premium assistance, pharmacy co-payment assistance and co-payment waiver assistance for persons with specific expensive chronic illnesses. Source: http://www.uneedpsi.org/about.cfm.
PSI's website goes on to state that people affected by certain specific illnesses -- including psoriasis are eligible to apply, regardless of income. Source: http://www.uneedpsi.org/eligibility.cfm.
We know nothing else about them, but it still can't hurt to check them out. (Unfortunately, Tani (tmartha) recently posted () that PSI has exhausted their budget for psoriasis. That being said, it still can't hurt to check them out.
Miranda (LadyFrasier) was able to get assistance for Enbrel while her husband was transitioning from being self-employed (with no insurance) to working for the government (with excellent benefits) thanks to a program called www.needymeds.com. Links to her story and in a thread that was started by Leslie (Momtotwogirls) . Leslie took the time to post the links and information about some assistance programs that she came across. I added the links and information about other assistance programs that have either been discussed here on the board or that people have told me about. Again, with the exception of www.needymeds.com, we don't know very much about these programs, but it still can't hurt to check them out.
I hope this helps.
Good luck.
Keep us posted!
Mike

Hi all,
This is an exhaustive issue, but it is critical not to give up. I have fought the insurance companies so many times over the years it makes me cranky to even remember, yet every time I won. It takes incredible perseverence, and a complete understanding of your own coverage ( from reading the policy ).
These very issues are the ones I was talking about when we were at CHD just a week or so ago. It is unjustifiable that patients like ourselves should be put through these kinds of trials just to have access to treatment, yet we have been goiNg through it for more than 30 years, at least in my own personal experience.
I am currently being denied access to Remicade, after having been approved for Enbrel for more than two years, with the original dx as pa. Of course, BCBS knows that if they deny long enough the Remicade is going to be an issue as far as starting it again. BCBS flat out stated that since it seems that my skin disease is worse than my pa, it seems that I am using the Remicade to treat that primarily. Since it works for the skin disease, that is a reason to deny the claim. They say that because it works for the skin as well, and is not FDA approved yet for that, I should be a self pay. What a load of crap!
My policy clearly states that Remicade is a medication that is indicated in the treatment of pa. It says it in black and white.
Needless to say, I am in process as far as this is concerned, and have called in all of my Dr's in the process ( they are all most willing to do whatever it takes ). I believe that just as it has been in the past, eventually I will be successful, but the process just sucks. We, as psoriasis patients, should not have to go through this, we need better access to treatment. As Rosie said in DC, if WE ARE THE PATIENT ADVOCATES AND WE ARE HAVING THESE PROBLEMS THE SYSTEM IS BROKEN.
The only soution I know to dealing with the coverage issues when it is clearly stated in the policy that it exists is not to give up trying, keep a good paper trail, and pay close attention. Stay after them, and do not give up. Wish that I had better advice. The only other thing that I can suggest is to write to your Congress.
Regards,

:) Thank you Mike K for your input,. it is so nice that we all help each other. I sent an email to npf so we will see. kristiz722 you hang in there to, we have to keep fighting

baka,,,,,,are you retired military? Do you have TriCare For Life? I do and all I had to pay for Enbrel was a $9.00 co-pay. I could get it forever but it did not help me and made me sick.

hi krista,
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 week end all
richard

Wow - thank you for all the support. I just happened on this message board and never occurred to me to find a board before. I am going to try everything suggested. I won't give up on BCBS. My Dr. and I just don't understand what they are doing. Dr. finds them very unusual because they have sent basically the same letter to us three times but won't talk to Dr. on the phone.
Anyway, thank you for the energy boost to keep trying. Kristi