I'm trying to get approval for Enbrel. I've had 2 horrific flare ups of PPPP and PA in the past several months. I've had my knee drained and injected twice. I got the second draining and injection yesterday. What an improvement! I'd run 101 fever for 6 days. Miserable.
Anyway, I don't want to take MTX, which Blue Cross generally requires before taking Enbrel, which is what I want to try. If anyone out there has bypassed the MTX requirement to get Enbrel or another drug, please tell me how you did it and/or what your doc advised the ins. co. to get that done. My rheumy is the doc trying to get me on the Enbrel, even though he would like me to try MTX first. I just don't want to. Plain and simple.
Thanks in advance for any help!

My derm has a person who's only job is fighting insurance for Embrel.
When you apply, list every part of your body where yo have P or PA.
I have it on my hands, face, feet, and privet parts.
List things that it effects.
Work (I write/program for aliving, haveing it on my hands was a big issue). Releationships, ablity to execrise, self esteem, etc. The the pain and handicap of the knee and draining.
List everything you have tried. topicals, ets.
Ask you doc if you should mention drinking as a reasonto not take mtx.
Try a different doc. I think docs who have experiance with Embrel, ect will be less likely to recommend mtx.
The people at Enbrel and the npf can help fight also
If you want a bioligcal, you should not have to take mtx first.
Dennis
Dennis

I agree with what Dennis says. Dealing with insurance companies in trying to get them to approve our chosen methods of treatment is such a hassle, and I truly believe that having to deal with our conditions and then on top of that, having to deal with insurance companies telling us what is best for us, is a load of crap! Nonetheless, it is the only way to get what we need. Enlist as much help as you can: rheumy, NPF, etc. And write out the summary Dennis suggested. If you have a long list of meds that you've already tried aside from MTX, that may help. Good luck!
Jennifer

Hi CAKI I just started Enbrel 3 weeks ago I also have BCBS they said it was not required that I try MXT first although I did for 4 weeks I could not take it I got such bad headaches and vomiting I could not get out of bed for 2 days after my fourth 15 mg pill I will never try that again do you have a seperate company that handles your perscriptions I have CAREMARK I had to call their specialty pharmacy dept to get approval it only took a couple of days they were really helpful and I only have a $15 copay good luck LINDA

Insurance can be tough,no doubt about it. over the years,I have dealt with a number of ins companies in regards to enbrel. generally,they do want you to try other forms of treatments before biologics ( cost related issues of course). This usually includes topicals,uv treatments,etc. This only has to be documented that you have tried them it doesn'thave to be recent. so gather records from any doc's that have treated you. Many ins companies are no longer requiring you to try mtx before enbrel.(they will probably make you get a tb test though,but that's no big deal) We have a woman in the pharmacy who's doc said noto mtx just based on her family history and the ins said ok. Don't give up hope. Also,if you go to the enbrel web site,they have people there that can help you with ins issues.
Best of luck and I hope you find the relief you need.

My doc had me try MTX for several months. I was sick from it all the while I was taking it. It didn't do much for relieving my PA...he wanted me to up the dose and I flat out told him that I wasn't taking it anymore and I told him I wanted to give Enbrel a try. He didn't even flinch...just said ok and a month later I started on E....best move I ever made. I'm finding that if you stand your ground and demand alternative treatments, you'll get what you want.

Hi Caki,
The NPF has an insurance advocacy service that goes to bat for people who have insurance issues. You might want to give them a call to see if they have any suggestions for people who want to head off a potential issue -- such as a requirement that you try MTX first. Here's a link to their description of their service: and here's a link to their contact information: .
Eliven Services, which is Enbrel's customer assistance service, also has "Insurance Specialists" who deal with insurance issues. You might want to give them a call and see if there's anything that they can do for you. Here's a link to their description of their service: http://www.enbrel.com/enliven/insurance-basics.jsp.
I hope this helps!
Good luck. Keep us posted and I hope and pray that Enbrel turns out to be your wonder drug.
Mike