Insurance may pay after all....

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elcamino
Veteran Member


Date Joined Sep 2005
Total Posts : 1744
   Posted 5/22/2006 3:31 PM (GMT -7)   
I took your advice and followed up with the company that handles my pharmaceutical needs, which is different from my health insurance company.  They have no problems authorizing an additional 50 mg/enbrel per week.  I called the nurse in my rheumy's office and she explained that when my rheumy told me he had tried to double the enbrel dose with other patients on my insurance plan and been repeatedly refused, he was talking about my health insurance company.  Since January of this year, however, my health insurance company sold me to a pharmaceutical company for all of my  pharmacy needs.  As it turns out, this pharmaceutical company is fairly reasonable with higher doses of enbrel, and doesn't require a dx of plaque psoriasis in order to qualify.  The nurse is going to ask my doctor to up my dose tomorrow morning (he had already left for the day this afternoon).  I think there's a good chance I can get the enbrel 2X/week.  This way, I can give enbrel every single opportunity to work before giving up on it.  I'm so tired of switching drugs and having to start over from ground zero.  I'm not ready to throw in the towel with enbrel and go to kinaret.  After kinaret, there are all the IV transfusion drugs, which I really don't want to go to if I can help it.  I can live with enbrel injections 2X / week.
 
Elcamino
Current dx: Rheumatoid Arthritis
Suspected dx: Early Lupus/MCTD; Inflammatory Bowel Disease
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan


yalinda
Veteran Member


Date Joined May 2006
Total Posts : 1179
   Posted 5/22/2006 3:38 PM (GMT -7)   
good luck with that and i hope it works out well for you! i am not familiar with enbrel, but do hope the 2 shots will be enough to get you through the week. i dont know if i could do shots.... i am needle phoebic.... just the thought scars me. i guess if you have to do something you just do it! keepin touch yalinda

Ducky
Veteran Member


Date Joined Mar 2005
Total Posts : 3199
   Posted 5/22/2006 5:27 PM (GMT -7)   
Woo-hoo! Way to go Elcamino! Good luck to you, let us know what the doc says tomorrow! I'm so happy for you! Duck
Confirmed Diagnosis of - Psoriatic Arthritis/Spondylitis/Graves Disease/GERD/Scoliosis/Hiatal Hernia/Graves Disease of the Eyes/Chronic UTIs
Current Meds -  Enbrel/Prevacid/Synthroid/Nitrofurantoin
Past Meds - Inderal/PTU/Prednisone/Voltaren/Feldene/Mobic/Cortisone and Steroid Shots
Additional Supplements - Multi-Vitamin/Bromelian/Acidophilus/Green Tea


RAGirl
Regular Member


Date Joined May 2006
Total Posts : 28
   Posted 5/22/2006 6:20 PM (GMT -7)   
That's great to hear elcamino! It goes to show that we really do need to be our own advocates at times. Good job making the calls and getting things done :)

erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 5/23/2006 5:05 PM (GMT -7)   
Elcamino,
Really do give it TIME! I pray this is IT for you. I mean regarding TNFs. Adding another immunosuppressant is no sweat, but I hope this Enbrel is it!

When my GI had a heart to heart with me back in January when I started Imuran added to the Humira and upped the Humira dose, he said, "Realistically, look to about the summer time to notice some little results." And he was right. I'm glad I did not quit and head to Remicade when the were pushing to do so. The Humira after 9 months has begun to work.
I pray for you so hard! You're such a great person and a great asset to HW. Let's hope there are some magic bubbbles in those syringes!
erin
Active, Severe RA. Crohns. AS. Chiari Malformation & Right Brain venous anomoly. Partial complex seizures. Emphysema. Rheumatic Lung & Heart. MVP and Tricuspid prolapse. Had Lymes disease for 10 years.
Meds: Humira 40mg Q 4 days; Pred; Pentasan 4G; Imuran 50mg; Dilaudid; Diazepam; Avinza 30mg; Meclizine; MiraLax & too many others.


elcamino
Veteran Member


Date Joined Sep 2005
Total Posts : 1744
   Posted 5/24/2006 4:26 AM (GMT -7)   
Erin, you are so sweet!  Out of all the forums here on HW, this one is my favorite and truly the one where I fit in the most.  You guys have chronic illness just like everyone else on HW, but you still remain positive and upbeat.  And, you maintain your sense of humor!  See I can do color too!
 
I also pray that this enbrel will do the trick for me.  Me and my rheumy have been looking for the right medication for 10 months now!  I would have expected that we would have found something by now.  Clearly, though, I'm starting to respond to enbrel so I hope the increase makes the difference.  Rheumy has not gotten back to me yet about doing the preauthorization for the increase--nurse assures me, though, that it shouldn't be a problem.  I'll call today and see what's up.
 
You guys are going to have to clue me in on who the next American Idol is.  I won't be home tonight to watch the results show :(  I'm sure it will be Taylor, but who really knows?  Except Simon.
 
Elcamino (always fast, never slow, Elcamino)
Current dx: Rheumatoid Arthritis
Suspected dx: Early Lupus/MCTD; Inflammatory Bowel Disease
Current Meds: Enbrel, Plaquenil, Aciphex, Ultracet, Zyrtec, Allavert-D, Zantac, Tylenol PM
Past Meds: Relafen, Vioxx, Mobic, Voltaren, Sulfasalazine, Entocort, Prednisone, Humira, Reglan


yalinda
Veteran Member


Date Joined May 2006
Total Posts : 1179
   Posted 5/24/2006 5:21 AM (GMT -7)   
tongue  go art therapy tongue  
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