I just joined this group last week. I had questions regarding Enbrel and I got a lot of great replies, thank you.
I found out today that it will cost me $489./month out of pocket. That is the 20% after the insurance pays. I have Blue Choice PPO for Major Medical. I have National Medical Health for my prescriptions. The person I got off the phone, from 1800Enbrel told me that since I do not qualify for any help because of my income (even though we are a one income family) the options are to try and find an insurance plan for myself - that I have to pay - for prescriptions. That it would be very difficult to do this, since it is pre- existing condition and I already have prescription coverage.
Does anyone else have any ideas? I don't even know if I am making sense because I have been crying. How does everyone else afford this?
Samantha

Oh Samantha! I'm so very sorry! :( Here's a couple of quick suggestions.
About a year or so ago, during a previous discussion about high Enbrel co-payments, a poster who came and went quickly from the Board, suggested a program called Patient Services Incorporated or PSI. According to their website, PSI: my insurance co. just denied my using Enbrel, too unless I try and fail other less costly treatments. I'm sorry to hear that Annie. Every insurance company has some sort of appeal process. If you haven't already done so, you might want to consider filing an appeal. The NPF has an insurance advocacy service that will do what they can to help you with your appeal. Here's a link to their description of their service: . And, here's the link to a thread that discusses how the NPF was involved in one families appeal for a home light unit: . Also, the people that make Enbrel employ "insurance specialists" that try to help Enbrel patients with any insuance issues that may arise. It can hurt to give them a call. Here's a link to their description of their service: http://www.enbrel.com/enliven/enbre...n-insurance.jsp.
I hope this helps.
Good luck.
Keep us posted.
Mike

Great links Mike...thanks for collecting all of them. You should make that its own topic link and we should all keep bumping that up. Thanks, Bearman. I keep meaning to add all of these links to Leslie's two threads. (She wisely posted duplicate threads -- one on the Psoriasis Board and one on the PA Board.) Her threads are already chock-full of excellent information and adding these links to it will make a good thread even better, because all of the information will be in the same thread.
Mike

Karen (OuchyK) pm'ed me some links to some assistance programs that she read about on another site. We know NOTHING about them, but it can't hurt to check them out! Here's the links:
http://www.themedicineprogram.com/
http://www.medicationfoundation.com/
http://www.freemedicineprogram.com/
Hope this helps someone.
Thanks, Karen!
Mike

Samantha:
What are the insurance companies saying, specifically? My insurance wouldn't cover Enbrel before I went on MTX for three months and had negative results. Well, I wasn't willing to purposely damage my liver, and my doctor agreed with me, so he and the wonderful people at his office went to bat for me and fought with the insurance company to get them to cover Enbrel without my going on MTX first. True, it took 3 months, I spent a lot of time on the phone, and I made the people at my doctor's office stressed out a little bit, but it was worth it ...

Initially my Perscription Drug coverage denied Enbrel as well. I went back to our benefits person, and she gave me the name of our administrator at the perscription drug company. Turns out that I just needed a letter from my doctor stating why he thought I needed Enbrel and that I had failed other forms of treatment. It was still expensive, but then they said well if you use our mail order it will be a lot cheaper and it was, $60 for 3 months. You might want to give it another try. I would have never found this out if I did not bug them.

I too was worried that BC/BS would not cover the $$ for the perscription, but gave it a shot anyways. Well, I was covered and was able to use my company's Perscription mail order service to order a 90 day supply which cost me a $75 co-pay. That floored me because the retail cost for 90 days was $3750.00.