Insurance wont cover Enbrel :(
Ok so I went to the derm yesterday and they prescribed me Enbrel, which I figured they would and I was really excited about this. So I had to take my prescription to the pharmacy and I was like ok so does my ins. cover the enbrel and he was like no it says here it doesnt. My doctor said that may happen and to have them call him. So I am waiting to here back from the pharmacy today to see what happens. I know MikeK has some links to places that can help with prescription costs. Im not sure where those threads are can anyone send me a link!? Or does anyone have any other suggestions on what I should do if my insurance decides not to cover it!??? Thank you so much!!
Ashley

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This is happening because Enbrel is FDA approved for RA, not p and PA. If you fight and they still say no, I would see about Amevive or some other FDA approved biologic.
SHANA

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Thank you :) Isnt Amevive almost the same as Enbrel? I dont know too much about that one....I am willing to try anything at this point.
Ashley

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i am pretty sure it is approved and as far as insurance im fighing the same thing . find out if its in your policy and if so call and call and call

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Enbrel is approved for both P and PA now. Also, enbrel and amevive are extremely different..not that it matters, it's actually a good thing because is if one does not work then the other may.

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Chaim,
Hey I just called my my ins co, and they gave me the number to where my prescriptions come from. They said it was denied because I cant get it at the pharmacy and it has to be sent to my home. You were right :) Of course they still have to call my doctor and stuff, but i think it is going to work out! :) They are going to call me back and let me know what my co-pay will be....I hope its like 10 dollars, yeah right! We will see though!!
Thank you all so much!
Ashley

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You might want to check with your insurance yourself. Mine would not cover it at my local pharmacy (Walgreens) but ok'd it through their mail order company. I pay $45 per month and it is shipped FedEx overnight.

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heather F,
Yeah u are right, I called them a little while ago and they told me the same thing. I cannot get it through my pharmacy. They are going to send it Fed Ex also. What mail order company are you going through if you dont mind me asking?? Mine is Caremark. They seemed to be really helpful.
Ashley

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Most of the mail order pharmacies are specialty places and are very helpful with insurance. They will ship fedex overnight in a package with ice packs to keep the meds cold.

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Wow it looks like the mail order pharmacies really take care of people :) That makes me happy. I cant wait to get my meds! I am really psyched about it!!!
Ashley

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I saw some earlier references to the above. I would really appreciate it if someone could provide phone numbers or links to those mail order pharmacies that will accept insurance for Enbrel. My local pharmacy wants $775 as my co-pay for a months supply. I'm hoping a mail order place may require a smaller co-pay. Thanks in advance for your help.
Brian

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Brian,
Many insurance companies have deals with these mail order pharmacies, so what's really necessary for you to do is to call your insurance directly and ask if there is a specific pharmacy they use for injectable medications.
If you'd like to call the phramacy that I used, its Advance PCS Specialty Rx and the number is 972.587.1241.

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shshsh i wish i would have had that kinda luck
i called and called and called again
i asked about the mail order thing and they said nothing there must be 1,000 employees at blue cross to answer the phone and put ya on hold and send you from one to the other . like the commercial with david spade . NO
NO NO I DONT KNOW NO NO NO OH YEA No
i finally got a letter saying they aprove enbril but got another letter saying paying for it has to be aproved when they get the bill . duhhhhhhhhh
i have to pay $6,500 out of pocket then they pick it up
sungto jingle bells ofcourse
oh what fun it is to ride with bluecross up my butt hey
hi hollis havnt talked to ya in a while how you doin .wanna fight about something or somthing . lol happy holidays bro

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they are making you pay 6500 out of pocket. WOW! If that was me I wouldnt be able to afford that. That just seems a little ridiculous to me. WHY CANT PRESCRIPTIONS BE CHEAPER!! ARRGGHH!!! Sorry had to let that out, lol.
Ashley
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