Hi everyone...I'm new to posting on your message boards but not new to psoriasis or PA. I've had P for over 40 years, and PA for about 5.
I searched the message boards before posting this to see if anyone has addressed the insurance cost of Enbrel, but I couldn't find anything. Forgive me if this issue has already been discussed.
I've been on Enbrel for 1.5 years with miraculous results (completely cleared) and *knock on wood* no side affects. I take a 50 mg injection every other week.
My insurance had wonderful prescription covereage. I only had to pay $20/month for Enbrel. However, I recently lost my job and now have coverage on my husband's insurance and I almost fell over when I picked up my prescription and discovered my copay was $381/month!!!!! Even the girl at the pharmacy thought it was a mistake and told me this is the first time she's ever seen a copay even close to that for ANY of their customers!!! To make a long story short....I did contact the insurance company and everything is correct....they basically said I should feel fortunate that I *only* have to pay $381 for a $1500 drug!!!! Talk about kicking you when you're down! :mad:
I am applying to the ENcourage Foundation for copay assistance but they will only give me $100/month if approved. No one there will tell me what the income guidelines are in order to get approved, so I'm not very hopeful.
So, my question is....do any of you out there have a high copay like that? Are there any other alternatives for financial assistance? I'm also wondering if there is another drug I could take that is similar to Enbrel and might have better ins. coverage?
Thanks!
Lynn

Hi Lynn,
Welcome to the Board! :cool: Nice to meet you. I'm sorry to hear that you lost your job and that your husband's insurance has such a high Enbrel-related co-payment.
A couple of years ago, during a prior discussion of high Enbrel co-payments, a new poster -- who sadly came and went quickly from the Board -- mentioned (here's a link to her post: ) a co-payment assistance program called Patient Services Incorporated or PSI. According to their website, PSIBefore whiching jobs I was insured by BCBS paying only the 25.00 co pay for enbrel & Dovonex 0.005. Now, Humana is now steal food from my mouth with coverage of only 75% leaving me with a bill of 381.00 for only FOUR SHOTS. Needlessto say, I had no other choice but to change scripts. I am now on Clobetasol 0.05, Dovonex 0.005 and just started UVB light box treatment at my doc's office. With my luck Humana is going to refuse the light box treatment. Does anyone else have Humana issurance issues??? :mad:
I have access to two insurance programs:
1) pays for everything but only up to max of $1,000 on drugs per year - that would leave me with $9,000 out of pocket for Enbrel
2) won't pay for Enbrel at all unless I can establish that Mtx is not suitable
So, Enbrel is essentially not an option for me. A lot of people are in my shoes. And it will only get worse as more and more insurers get stricter and stricter.
I'm sorry that the two of you are having issues getting Enbrel covered by your insurance companies. In my previous reponse in this thread, I mentioned that Patient Service Incorporated (http://www.uneedpsi.org/about.cfm) states on its website that it provides co-payment assistance, regardless of income, to patients who suffer from specific chronic illnesses, including psoriasis. We don't know very much about them, but it can't hurt to check them out. Also, Sue (Beachbound) was able to significantly lower her Enbrel related co-payments after the people who make Enbrel arranged to have her prescription filled at a mail order pharmacy. Here's the links to her story:

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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 the NPF's contact information: .
Finally, Leslie (screen name: Momtotwogirls) mentioned when she took the time to post the links and information about several assistance programs that she came across. I added links and information about several other assistance programs that have either been discussed here the Board or that other posters have told me about. We know nothing else about most of the other assistance programs. However, it can't hurt to check them out. Here's a link to Leslie's thread: .
I hope this helps.
Good luck. Keep us posted!
Mike