Enbrel coverage under insurance | Arthritis Information

Hi Everyone,

Has anyone had any luck with getting Enbrel shots covered under insurance? Has anyone had any experience with Blue Cross Blue Shield? I am looking for employement, and the company I am interviewing with has BCBS insurance. I worry that I couldn't afford the shots.

Take care,

Nori

it all depends on the indicidual coverage of the company. Even BCBS shield policies will differ from employer to employer. I had a .00 co pay on BCBSI had them on Empire BC/BS PPO, and my payment was 0 for 3 months through their specialty pharmacy.I have a PPO BCBS - Cost me 0 for a 3 mos. supply. It is totally what your policy is. Also, before humira/enbrel, you usually have to fail other types of meds for coverage.For this first year, with the Quick Assist, it didn't cost a thing. I also have PPO BCBS and starting January will cost me 0 for 3 months. As someone has said before, the benefits can be different from company to company.

I have BC/BS and it costs me for a three month supply...Hiking_galI'm sure you are taking this into account, but enbrel doesn't work for everyone, so I hope you are basing your employment solely on that. I used Enbrel for a while but then it stopped working. Good luck.

[QUOTE=Debrakay]I have a PPO BCBS....Also, before humira/enbrel, you usually have to fail other types of meds for coverage.[/QUOTE]

Enbrel, by itself without a traditional DMARD like mtx, was my very first med and I had no issues with it being covered. That may be a difference in policies or maybe my doctor convinced them of medical necessity or something.

My insurance required failure of at least one DMARD. I had failed three. I am on Enbrel through Aetna Specialty Pharmacy. It costs me per month for the copay through my company insurance. I make sure I have enough put aside in my Flex Account to cover the copays. Nori, I wonder if calling the Enbrel insurance specialists (see http://www.enbrel.com/ra/insurance-help.jsp) would at least tell you what percentage of BC/BS plans cover Enbrel. Even if yours didn't, it seems there are financial assistance programs you can contact. Good luck with it.Definitely sign up for Quick Assist. Your doctor can give you the information to sign up. They paid all my copay for the first year. Hi Everyone,

Thank you for all the feedback. I have been on enbrel since march '08. It has helped quite a bit and I am looking for employment as a result of this medication working. To respond to an earlier comment, I do rely on this drug and if it stopped working, I probably wouldn't be able to work. But I don't want to wait around to see if that happens.

Nori

I just re-read my reply (which made absolutely NO sense at all!) Anyways, I'm glad Enbrel is working for you and hope you find coverage that works in your favor too.

Phats

good that enbrel is working for you, nori !! I'm taking it w/ some positive responses but not remission... I have BC/BS PPO and pay /3 months supply...

Good luck in the job hunt...