Cost of Enbrel

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roja
New Member


Date Joined Dec 2007
Total Posts : 8
   Posted 12/9/2007 6:37 PM (GMT -6)   
I finally reached the conclusion that I needed the Enbrel since nothing else (in pill form, i.e. Arava, Imuran, etc.) was working. 
 
I have Oxford insurance and WITH health insurance coverage, the cost for 4 syringes (1 mos. worth, I'm supposed to take 1 injection per week) is $656!!!! There is NO WAY I can afford that amount per month!
 
Also, I was recently prescribed Celebrex.  Again, an exorbitant cost.  WITH health insurance, a month's supply cost $100 (60 pills, I'm supposed to take 2 per day).
 
For those of you on Enbrel and Celebrex, how do you afford it?  Are there health insurance companies that give better coverage?  If so, which ones? I purchase my health insurance privately so I guess I could switch if there was a particular health insurance company that provided better coverage.
 
I understand there is no generic Enbrel or Celebrex.  Is there any way to purchase it cheaper?  
 
Also, another question, does anyone know if I will be rejected for AARP coverage because of the rheumatoid arthritis?
 
This becomes a bigger nightmare by the day.  After I finally convince myself that I need to take stronger drugs because I'm in terrible pain, now I can't afford it.  
 
Any solutions/options to this ridiculous cost???  Please let me know. 
 
 
 
 

Ducky
Veteran Member


Date Joined Mar 2005
Total Posts : 3199
   Posted 12/9/2007 7:10 PM (GMT -6)   
Hey there roja.. I know, the costs of these meds are just ridiculous.. Most companies (Enbrel is one of them) have an assistance plan.. you can get the med at little to no cost to you.. They should have some of the info on their website, and if not, you can call their 1-800 number and ask about it.. Good luck to you, and let us know how you do!
Moderator of Arthritis Forum
Confirmed Diagnosis of - Psoriatic Arthritis/Spondylitis/Graves Disease/GERD/Scoliosis/Hiatal Hernia/Graves Disease of the Eyes/Chronic UTIs/Migraines/Hypertension
Current Meds -  Enbrel/Prilosec/Synthroid/Nitrofurantoin/Midrin/HYZAAR
Past Meds - Inderal/PTU/Prednisone/Voltaren/Feldene/Mobic/Cortisone and Steroid Shots
 
 


yalinda
Veteran Member


Date Joined May 2006
Total Posts : 1179
   Posted 12/9/2007 9:01 PM (GMT -6)   
call enbrel, ducky is right your cost should go way down maybe nothing?

leeloo67
Regular Member


Date Joined Aug 2006
Total Posts : 81
   Posted 12/13/2007 10:01 AM (GMT -6)   
I just found out this morning also that I might be going off Enbrel due to cost!  My pharmacist called me first thing this morning with a rude wake-up call.  Said I owed $1,800 for last month and $1,600 for the new script being filled today.  I have Blue Cross, so my doctor is calling them today to find out what is going on.  If she has bad news I will call Enbrel and see if they can help! 
 
With all the other medications I've taken I wouldn't care, but Enbrel so far (five weeks) has worked great.  I'm about 95% pain-free and have about 95% mobility.  With my luck I'm not surprised there is a problem with who is paying!
Arthritis (poss. RA) - Doc scripts: Enbrel, Methotrexate, Celebrex, Folic acid.  Self-scripts: Glucosamine, GNC Men's Sport multi-vitamin.


yalinda
Veteran Member


Date Joined May 2006
Total Posts : 1179
   Posted 12/13/2007 11:18 AM (GMT -6)   
leeloo maybe the preauthorization hasnt gone through yet??????? if not call enbrel for help! hey offer to be a test dummy, i mean smartty. lol i too love enbrel almost more than prednisone?

leeloo67
Regular Member


Date Joined Aug 2006
Total Posts : 81
   Posted 12/14/2007 9:25 PM (GMT -6)   
I had a big weight lifted off of me today. I called Blue Cross to find out what is going on and they said if I buy the Enbrel from one of four approved pharmaices (in the entire country), all I have to pay is the co-pay. I asked them to verify my co-pay amount for Enbrel and they said $25! I asked how that was even possible and it turns out Blue Cross bought a massive amount of Enbrel in bulk at a reduced rate, but only distributes it through those four pharmacies. If I go anywhere else to get it they won't pay a single cent. So, mail-order Enbrel for me it is!

Before I found this out I checked out the Enbrel website and they have a page dedicated to insurance problems and such. Sounds like they have the appeal process all set up to go if you just call them, and they also have info on healthcare providers.

It makes me a bit nervous that the only thing keeping me swimming in Enbrel at an affordable price right now is the whimsy of my health insurance company, but I guess I'll just have to hope it continues (and hope my wife doesn't lose her job and her insurance - and hope her job doesn't switch insurance companies!!!!).
Arthritis (poss. RA) - Doc scripts: Enbrel, Methotrexate, Celebrex, Folic acid.  Self-scripts: Glucosamine, GNC Men's Sport multi-vitamin.


leeloo67
Regular Member


Date Joined Aug 2006
Total Posts : 81
   Posted 12/31/2007 3:45 PM (GMT -6)   
Gosh, my post above as on 12/14 - still no Enbrel.  I called the Pharmacy for about the ninth time today and got yet another putoff.  They were about to send me the wrong stuff!  So, I've been off Enbrel since 12/10 (and off Plaquenil and lowered doeses of Celebrex and MTX!).  In case anyone is wondering if any sypmtoms have come back: not really.  Just a few little irritations in a few joints.  Even my perpetual acne that Enbrel seems to have killed hasn't returned.  Still, it would be nice to get some Enbrel back in my system...
Arthritis (poss. RA) - Doc scripts: Enbrel, Methotrexate, Celebrex, Folic acid.  Self-scripts: Glucosamine, GNC Men's Sport multi-vitamin.


yalinda
Veteran Member


Date Joined May 2006
Total Posts : 1179
   Posted 12/31/2007 4:41 PM (GMT -6)   
sorry to hear you still are waiting for the enbrel.......did you notice any notices in your mailbox????? i have mine sent drop off no cosign so i dont have to worry about not being there for the pick up. mine is always left on my front porch. it is so hard this time of year to get a hold of people so many are off with the holidays. good luck with your quest and again happy new year!

leeloo67
Regular Member


Date Joined Aug 2006
Total Posts : 81
   Posted 1/1/2008 8:37 PM (GMT -6)   
My problems were numerous and persistent communication problems between my doctor, the pharmacies, and the insurance company. I said "were" because the Enbrel is now on a Fed Ex truck and should be here in two more days! Just my luck though - out of coincidence, I have a mild respiratory infection right now! I hope it is gone by the time the stuff arrives...
Arthritis (poss. RA) - Doc scripts: Enbrel, Methotrexate, Celebrex, Folic acid.  Self-scripts: Glucosamine, GNC Men's Sport multi-vitamin.


Ducky
Veteran Member


Date Joined Mar 2005
Total Posts : 3199
   Posted 1/1/2008 8:53 PM (GMT -6)   
2 more days? They should be sending that stuff over-night to you.. it has to be kept refrigerated.. I hope it is a refrigerated truck!
Moderator of Arthritis Forum
Confirmed Diagnosis of - Psoriatic Arthritis/Spondylitis/Graves Disease/GERD/Scoliosis/Hiatal Hernia/Graves Disease of the Eyes/Chronic UTIs/Migraines/Hypertension
Current Meds -  Enbrel/Prilosec/Synthroid/Nitrofurantoin/Midrin/HYZAAR
Past Meds - Inderal/PTU/Prednisone/Voltaren/Feldene/Mobic/Cortisone and Steroid Shots
 
 


leeloo67
Regular Member


Date Joined Aug 2006
Total Posts : 81
   Posted 1/2/2008 12:17 PM (GMT -6)   
The shipment I got last month direct from the manufacturer (the first one is free!) came in a disposeable cooler with some sort of frozen chemical in a bag that kept it very cold. I actually told them there was no immediate rush due to me currently having an infection!
Arthritis (poss. RA) - Doc scripts: Enbrel, Methotrexate, Celebrex, Folic acid.  Self-scripts: Glucosamine, GNC Men's Sport multi-vitamin.


Ducky
Veteran Member


Date Joined Mar 2005
Total Posts : 3199
   Posted 1/2/2008 6:08 PM (GMT -6)   
Well, good luck to you.. I get mine from a mail order pharmacy too, but they send it over night in a cooler with a freezer pack, and sometimes those are melted by the time they get to me the next day.. Maybe with it being colder outside, yours should be ok by the time you get it
Moderator of Arthritis Forum
Confirmed Diagnosis of - Psoriatic Arthritis/Spondylitis/Graves Disease/GERD/Scoliosis/Hiatal Hernia/Graves Disease of the Eyes/Chronic UTIs/Migraines/Hypertension
Current Meds -  Enbrel/Prilosec/Synthroid/Nitrofurantoin/Midrin/HYZAAR
Past Meds - Inderal/PTU/Prednisone/Voltaren/Feldene/Mobic/Cortisone and Steroid Shots
 
 


Sunpuppy
New Member


Date Joined Dec 2007
Total Posts : 15
   Posted 1/3/2008 9:20 PM (GMT -6)   
I didn't have any luck with calling Enbrel or Humira for assistance in the cost of the drug and my income is minimum. My ins (Humana) pays 75% but 25% is still a chunk of money when the drug cost anywhere from 1500 to 1700 a month depending on the pharmacy (surprizenly Walmart was the highest but maybe they will price match) I finally got help calling "Patient Assistance" who gave me a four thousand dollar grant for my Humira but that don't cover the high out of pocket copays during the donut hole. I'm open for suggestions and desparate as by mid Feb I will be in the Medicare donut hole and can't afford insurance to supplement. I can't believe how expensive it is to treat RA.

leeloo67
Regular Member


Date Joined Aug 2006
Total Posts : 81
   Posted 1/3/2008 11:06 PM (GMT -6)   
Is there any way you can get on with a "better" insurance company, Sunpuppy? I've been through several companies and it is only blind chance that I happen to be with Blue Cross right now and they had the foresight to buy a large quantity of Enbrel at a reduced price.

The whole deal with the cost of this stuff has really made me think about what I would do if I couldn't get my hands on Enbrel (which really seems to be working for me so far). I actually finally got my shipment today (and FYI it arrived in a disposeable mini-cooler with chemical ice packs inside). But I was just off Enbrel for 24 days and it is supposed to be taken every seven days, and I didn't have any serious return of symptoms. Is every seven days the "only" way to take Enbrel properly? I'm going to ask my doctor in March when I see her again. Anyway, I think what I might do if I had to fork out a big chunk of money is get the Enbrel but not take it every seven days, but rather stretch it out to every two weeks or maybe even every three. I know this is not proper at all but I think I would be desparate enough to do it. There is no way I could afford what some people are required to pay. I can't believe that an existing treatment for a disease simply isn't available to some people just because of money.
Arthritis (poss. RA) - Doc scripts: Enbrel, Methotrexate, Celebrex, Folic acid.  Self-scripts: Glucosamine, GNC Men's Sport multi-vitamin.


nathan's nanna
New Member


Date Joined Sep 2012
Total Posts : 2
   Posted 9/4/2012 9:57 AM (GMT -6)   
I too had finally come to the conclusion that I needed Enbrel. I can barely walk. So I applied for the Enbrel copay support (mine was $1600 a month after Federal Blue Cross). I was accepted. However, there is a catch here. The support only pays up to $4,000 during a six month period. So, needless to say I won't be able to take Enbrel. Looks like a wheelchair and stronger pain meds for me.

momto3
Veteran Member


Date Joined Nov 2006
Total Posts : 1331
   Posted 9/4/2012 11:34 AM (GMT -6)   
The Enbrel support is supposed to pay $10 or your co-pay whichever is less, and it is zero for the first six months. I have been on Enbrel since April, and have not had to pay any of the $100 copay required by my insurance. It is true without insurance it runs around $1200 per injection and I am meaning the sure-click autoinjectors.

nathan's nanna
New Member


Date Joined Sep 2012
Total Posts : 2
   Posted 9/4/2012 1:21 PM (GMT -6)   
They explained to me that what you say about the $10 co pay is for the SECOND six months on. It says it in the paper work they sent to me as well that for the first six months they pay up to $4000.00 of the copay and anything after that is the patient's responsibility. What type of insurance do you have? $100 co pay is a great deal less than $1600. I think I need to call my pharmacy and see what is going on. You say $1200 per injection. My pharmacy told me it was $1600.00 co pay AFTER insurance. Something doesn't sound right here. Thank you for your response. I am going to look into this as soon as I leave work today.

momto3
Veteran Member


Date Joined Nov 2006
Total Posts : 1331
   Posted 9/5/2012 6:28 PM (GMT -6)   
We currently have Aetna and right now I am paying 0 out of pocket, and like you said after the first six months it would be 10. Yes, on our prescription plan we can enter in a script and it will tell us the cost of a medication before and after insurance. Using Caremark, the cost *before* insurance for Enbrel sureclick is $1200 per pen, not per box.
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