Hi guys:
Well, my stupid insurance company refuses to pay for my Enbrel. They say I haven't been been through all their "steps" yet. I guess I understand that, but having been recently diagnosed with PA, it makes me kinda concerned that more damage is going to be done before I can get Enbrel. I have an appointment scheduled with a rheumatologist in late June. Is there any hope that he can gang up with my derm doctor to pursuade my insurance company to change their minds?
Donna

Hi Donna,
UGH, sorry that happened. :( Yes, I think with a confirmed diagnosis of PA it will help, at least I hope so.
In the meantime please go here and see if the NPF can help you.

I would also call Alyssa Brown from the NPF and ask for her advice.
Good luck!
Karen

Hi Donna,
I'm so sorry. File an appeal. The sooner the better. Get both your derm and your rheumy a involved. Also, please get in touch with both the NPF (they have an insurance advocacy service) and Enbrel's customer assistance service, which is called Eliven Services. Both the NPF and Eliven Services go to bat for people who are having insurance issues. Here's a link to the insurance section of Enbrel's website: http://www.enbrel.com/enliven/insurance-specialists.jsp. Here's a link to the NPF's description of their insurance advocacy service: . And, here's a link to the NPF's contact information: . (If push comes to shove, you can also file a complaint with your state's insurance department or commission.)
I hope this helps.
Good luck. Keep us posted!
Mike

I know that my insurance requires us to try methotrexate first.

MTX is a requirement of mine also, but my derm doc was hesitant to put me on that because I'm still in my child-bearing years, even though I have no plans to have children. There was a list of 6 or 7 other requirements (i.e., cortisteroids, so many topicals, UV therapy for at least 6 months -- how is that supposed to help my PA?)
Anyway, I appreciate all the advice. I'll await the actual denial letter from my insurance before I file an appeal, but in talking with my doctor's nurse, I have little or no chance of being approved until all steps have been completed.
Keep your fingers crossed for me that I'll have more luck with the rheumatologist!

Call the NPF and keep working with your doctor. Good luck.

MTX is a requirement of mine also, but my derm doc was hesitant to put me on that because I'm still in my child-bearing years, even though I have no plans to have children. There was a list of 6 or 7 other requirements (i.e., cortisteroids, so many topicals, UV therapy for at least 6 months -- how is that supposed to help my PA?)
Anyway, I appreciate all the advice. I'll await the actual denial letter from my insurance before I file an appeal, but in talking with my doctor's nurse, I have little or no chance of being approved until all steps have been completed.
Keep your fingers crossed for me that I'll have more luck with the rheumatologist!
It should be up TO YOU not your dr. if you are willing to take MTX. It's your body. My rheum had no hesitation.

I was on mtx for a year and suffered quite a few sides, such as overwhelming fatigue and mental fog (more than age related!) that made many tasks too much of a burden. I started Humira in February and after 3 months found that it 'ran out' after about 10 days so my rheum sent a request to my insurance company (anthem) for weekly, which was denied since I was taking 'concomitant mtx.' My rheum found it interesting that they have formed a medical opinion since there isn't anything in research or drug info that supports that. She took me off mtx and wrote again and they approved. Perhaps an inability to take mtx is reason enough. Good luck and keep trying.
patti

You should try to get your doc to appeal.
Make sure you comument everywhere you have P or PA, and what effect it is having on your life, and all the topicals, ect you have tried.
You should also call the rhumy and see if you can get an earler appt. On second thoouhg, have your derm call, if you derm says you need an appt sooner, the rhumy will likly work you in. All talk to the rhmys schedluig person and make sure you are high on the list if someone cancels an appt.
Dennis

I wonder if it'll make a difference if the rheumatologist writes the prescription, rather than the derm. It would certainly appear to eliminate some of the requirements that you listed, given that they are certainly not arthritis treatments. As for taking methotrexate during your child bearing years, as someone else said, that decision should not be made by the doc alone. I am a firm believer in the medical team, which includes the patient and/or caregiver!
Liz

Yes a Rhumy opinon makes a big difference.
P is generaly considered cosmetic, but joint damage is real.
Also PA responds to different treatments.
Kasier Permante does not allow derms to rx Enbrel, they have to rx Humira or other stuff.
But Rhumys can rx Enbrel.
Dennis

Good morning....
Just thought I'd give you guys a quick update on my rheumatologist visit yesterday. He said I have a textbook case of PA, and since I haven't received the official denial from my insurance regarding Enbrel, he decided to start me on Methotrexate and folic acid. He also ordered x-rays for both hands and feet. I asked him if I had arthritis mutilans, and he said he would know for sure once the x-rays were in.
He also assured me that if I don't see significant improvement within 3 months, then he would do what he needed to do to get my insurance company to see things his way. I really liked him -- he kept telling me that I definitely came to the right place, and that he could help me. He was also very thorough -- I spent about an hour and fifteen minutes with him. Don't you just love it when you go to a doctor and finally feel like you got your money's worth!!!!
Donna

Donna,
Sorry to hear about your dx, but better to know what your dealing with and having a knowledgeable professional on your side!
I'm glad you had such a postitive experience with your new rhuematologist. A good doctor is worth his/her weight in gold.
Good luck with your treatment.
Karen :)