There must be some powerful political stuff going on there - to not even accept the co-pay assistance card.

This stuff just gets worse and worse.

yeah as it is read, you can pay if you want and if your manufacturer wants to pay back you, when then lucky you, but we are not taking it in the first place. why? is it negotiated for less than the face value of the co pay?

crap.

can we get together in our wheelchairs, walkers, and canes and become lobbyists as a gang?

depot

This makes me furious!
Something is up. Enbrel being one of the most used for treatment upon diagnosis.
Perhaps this has something to do with the war between pharmaceutical & insurance.
Back when there were 2 choices to start controlling RA. Humira or Enbrel. Now the way I understood both were covered & expected as first line of defense by insurance.
From your story Coal we know That is not the case with Humira.
Now Enbrel? I had United when I started Enbrel.
The only ones paying are the patients.
These medications are not the safest yet they are playing with patients choices. It seems targeting the first medications most recommended by doctors. Perhaps allowing pharmaceutical to drive prices up? Guessing at whys here.
Depot you may be onto something with all kidding aside.
Who is mediator here? Is there anyone at all attempting to watch out for the patient or consumer?

For those with private insurance costs are way up & coverage is down. Some could argue there's no obligation from insurance to cover certain meds. At the same time these companies have the patients jumping through hoops to get the medication they need. Ruling other medications out first. Which if I understand can be more costly.
The decision to use one med over another is between a doctor & patient.
I'm not loving my dr at the moment but Orencia was the med of choice based in part because of fewer side effects. This was decided because of my reactions to other medications. Now insurance dictates cimzia must be tried before Orencia will be covered.
The out come was chemically induced asthma. The very thing we were hoping to avoid. Nasty side effects that can be harmful. Outcome is it actually drove medical costs up with added doctor visits & treatment. Who won there? No one!

Price gauging has been questioned in the past with other industries.
Unless I'm misunderstanding in part that is what has occurred with some medications.
Now co pay assistance is not accepted from insurance. Sure appears it may be in part this battle between insurance & pharmaceutical.
With us caught in the cross fire.
This concerns me more then I can say. Hard enough to get some doctors to do their part. So if this becomes a huge burden to doctors is the cost going to sky rocket with there also?
Someone has to handle all this paper work & requests. At this rate they will need a separate department just for this.
I've mentioned this before. At my most recent appointment at my PMs a patient brought a script back for Celebrex stating insurance no longer covered it. No problems in the past but no longer under coverage. This is going to become a huge problem.
If United is not accepting co pay assistance other insurance will follow. Mark my words.
Perhaps those who have a choice should blow off United health care.
I'm really wondering why we are not hearing more about this through the media? Something like this should be brought to the publics attention & watched.
Mostly just My opinions for what they are worth.
Sammy

I don't have this insurance but based on what I see here: *and this doesn't refer to RA. So perhaps RA stays as is??

1. If you are already on it, you can stay on it. You will now pay the pharmacy the amount your insurance doesn't cover. So, if you have a copay of $100 you pay it. Of if you pay a large deductible, the $2900/mo supply must be paid by you first and ENBREL can reimburse YOU after the fact. ***Big question for many - will Enbrel do this and do people have the $2900 (or whatever it is) to pay.

There are a few ugly things here.

Let's start with the timing. Yesterday was the last day to finish up applications for January 1st coverage through the Affordable Healthcare Act, and this announcement came out late yesterday. If you signed up with United on Sunday, too bad.

Second, United is big, and national I believe. If they can get away with this, what will stop other companies from following suit?

Third, like so many other things, this will be a nuisance for the well-off and a catastrophe for those who live closer to the bone.

Bcatz, as I said in the original post, this notice was sent to us on the NPF's email list. It doesn't mention RA, but Enbrel is a firstline, well-accepted for over a decade, treatment for both psoriasis and psoriatic arthritis. Phil Mickelsen, the Enbrel shill, has PsA for what that's worth. My guess is that they have RA, ulcerative colitis, and Crohn's patients in the crosshairs, too.

Sammy, it's just nauseating. The insurance companies and the hospital corporations are calling the shots. Patients are getting the shaft on one end, and doctors on the other. Much to the money boys' delight, they have managed to pit patients against doctors and make them look like the bad guys, eventhough our doctors are hamstrung by the same forces we are.

Depot, when and where's the riot? I'll be there.

Coaltrain, I'm still trying to twist my mind into a shape where I can understand how and why this is happening.

"this will be a nuisance for the well-off and a catastrophe for those who live closer to the bone. "

this is what makes you an awesome human being, alto. your NON "I got mine" attitude.

on behalf of those who lives near that bone...or veggie ball (sorry)
thanks

Depot

I understand the correlation. And it's sickening. I hope it gets challenged quickly! Or that Enbrel finds a way to assist pay in advance??
And it's also scary for those that are in clinical remission and are ready to stop their Enbrel for a bit. Or what about those that need to quit for several months for surgery and recovery? Then they won't be a current user.

Not sure what all this means...but it does make me nervous!!! I have been on United Healthcare for at least 10-12 years and I have been on Enbrel since 2009. I can order one more month's supply before the end of the year, but don't know what will happen next year....I call Prescriptions Solutions for my Enbrel and it is mailed to me. My current co pay is either $30 or $37 for month's supply. I think I need to do some checking on this.....

In the link click on the part I have put in parenthesis. It is a letter by UHC with a note at the bottom on who it affects. Not a lawyer, but maybe some of us will not be affected. I have Optum/RX. It also says if you are currently on Enbrel you will not be required to try another drug.

The National Psoriasis Foundation is in "contact with UnitedHealthcare" (click on that) regarding this matter and is monitoring the situation. We will keep you informed as we learn more.

What I think is going on is the ACA didn't touch medications in their mandates. The insurance companies are still PO'd about the fact that a percentage of their coverage has to go toward actual coverage and what isn't is supposed to be reimbursed. 80%?? That cuts into their profit margin. More insurance companies are merging (I think there's 5 or so left) and insurance companies are using "vendors" like ExpressScripts (who seems to own everyone just using different names) now for prescription benefits coverage. Less competition and an aim to recupe "lost" revenue and this is what we get.

They kept fighting to push back the ACA start date to give themselves time to manipulate the system behind the scenes. They're making deals with drug cos that offered them the best rate. More generics mftrs are stopping some meds entirely causing shortages of some meds and huge price hikes on others. (Someone posted that article recently) Plaquinel is one. That price has jumped from like $25 a mo to the neighborhood of $1000 in a month. For generic! All in the month before the ACA is set to be fully live. Premiums have shot up as well. Granted they're known to increase yearly but not doubling & tripling. All of it stinks to high heaven.

Georgia has actually made the ACA illegal. So I'm no longer eligible for subsidies at all. It wasnt much but it was something. They also declined the Medicaid expansion which not only affects those subsidies but also the state children's healthcare insurance program-SCHIP. That change means unless you have a family of 4 making less than $40k you won't qualify yet no insurance plans being offered want to cover my kid. The healthcare website keeps referring me to the state program & they won't cover him either. The rates I'm being quoted are for 2 adults. So what choices do I have to get insurance for my minor child? I can only surmise that they don't want to be forced to cover him til he's 26 as required by the ACA.

The Medicaid expansion also provides funds for state run hospitals. 6 have closed in rural Ga in 2014. Rural areas tend to have higher poverty rates. So those people no longer even have the option of an ER for medical treatment. Apparently they're just supposed to go home & suffer until they die.

This whole thing has got me riled up to the point of migraines. The state, whose #1 industry is healthcare, turns down free money from the feds that would help millions of its residents live better, healthier lives and instead outlaws it to benefit some fatcats instead. Did I mention our newly re-elected governor id under investigation for taking bribes from the aformentioned fatcats both before and after the bill was passed? He left Congress for ethics violations too. He rivals Rick Scott for the slimiest governor.

Ironically, the cheapest plan available is $750/mo and that's thru United Healthcare! The next is Humana and that's $900/mo. I'm still waiting for a return call from UHC to find out if they cover pre-existing conditions and if they'll cover my kid. Since the ACA is now illegal I'm not sure if they have to follow the ACA rules. There may be a loophole in the law somewhere. If they don't my COBRA coverage runs out mid-July and I'll be without coverage for the foreseeable future. The premiums will be out of reach for the companies that will cover me. As we all know RA is expensive. I can't even afford the policy I have now that is increasing next month to $850 a mo.

330 million people's fate was decided by 6 senators and a boatload of lobbyists for the insurance industry.

Sorry for the book & the rant but it's my hot button lately and reading articles like thing just gets me riled up again. I'll be at the front of the pack for the riot. With bells on. And a megaphone.

All of this is just my opinion and conjecture based on watching this evolve over the last couple of years. Should've known the insurance cos would figure out a way. We're one of the last countries that allows them to do this. They have to pay their CEOs $16million dollar salaries somehow. (Last time I checked that was UHC's salary. The highest of them all)

Emerald

I should add that I've been awake for about 36hrs with joint pain that's taken over my hips & knees and more pins & needles numbness that's taken up residence in my right calf & foot rendering them useless. I guess my numb left thigh was getting lonely.

Being stuck in bed immobile in unGodly pain for the 2nd time in 3wks makes me an insufferable cranky Beyotch with a capital B.

Sorry again to the mega-rant.

Thanks for putting up with me ;)

Well you did not rant alone I was rating right along with you.
My uncle got a call from express scripts yesterday. One of his scripts jumped from 10.00 to 50.00.
He's 83. How sad.
Wonder what's the next one to go up.
Sammy

That is my fear. If one insurance does it the others will follow.
This is common with big industries.
What can we do?
Sammy

I'm not sure we can do anything other than write our congresspeople but that's probably as effective as spitting on the wind. They're how we got here to start with. The time to do something was when those 6 representatives of the people were sitting at the conference table selling us down the river. Since the negotiations were private only they had the power to do anything. And they chose to cower in the corner lest they lose campaign re-election money from the healthcare industry. The situation is so multi-layered and corrupted I'm not sure any of it can be fixed. Money rules everything. People don't matter anymore even though there's 330 million of us.

Corporations run the hospitals and the prescription services. Corporations own the media outlets. It's all about making a profit to keep shareholders happy.

I know I sound cynical and I hate it. But that's where (I think) we've ended up. 1% of the population holds 99% of the wealth in this country. Most of which is kept in off shore tax havens. A former president held "classes" to teach others how to do it.

Lobbyists write legislation to benefit their industries and give it to their Congressperson of choice to bring up for a vote. The Senate used to be a highly respected group of statesmen that negotiated and found common ground. Now if they're seen negotiating they're accused of selling out their party. They can't even beg people to run anymore. No one with any integrity wants to play in that sandbox for 6yrs. And the stalemate do-si-do continues.

Two brothers employ 65k in a private company and have just about every Congress member doing their bidding. The Keystone pipeline barely failed passage and they would've been the primary beneficiaries to the tune of 100s of billions had it passed. They even helped finance a whole new political party including the candidates to further their agenda. People don't give away money and not expect favors in return.

Another company is the largest in the world and their employees make such a pittance they're on food stamps while the sibling majority shareholders are consistently on the top of the Forbes richest list.

A huge financial services company that was fined for bilking taxpayers $100s of billions during the Wall Street debacle is only paying half their $300 million fine while the taxpayers are paying the other half. That same company also pays next to nothing in taxes along with several other huge corporations. If I had to guess that's another loophole written into some legislation somewhere along the way and they've all learned to benefit from it.

The deck is stacked against the consumer in every way in practically every industry. As they say the house always wins. When one gets away with something another one can too. It sets off a chain reaction of unethical behavior until it becomes the accepted behavior. The thing is those that made the laws were put there and stay there because we the people allow them to. I used to believe that truth & ethics would always win in the end. Now I'm not so sure. The Joneses have to "get theirs" and could care less if the Smith's have anything as long as they don't try to take what they have. The whole mentality from the top down is becoming one big pitiful cluster.

Emerald, Georgia actually outlawed the ACA? Talk about cutting off one's nose to spite one's face. Because it was proposed by a president whose party they don't like (probably because of something else about him they don't like, too) they are denying coverage to people who have pre-existing conditions or who make too much money to qualify for the old form of Medicaid but can't afford commercial insurance? What does this accomplish? Besides making them look like mean, ignorant, antediluvian reptiles?

Article in yesterday's NY Times saying that states that took the Medicare expansion are showing vastly smaller amounts of un-reimbursed hospital expenses. One might think that the moneyboys in the hospital and insurance industries would like this- less slack for them to have to pick up.

The ACA has been a godsend for our family. Both my husband and I are uninsurable by any company's standards. The policy we currently have (and that I just renewed) through the ACA is good insurance, and the subsidy makes it possible. Even though our governor is Republican she took the Medicaid expansion. Before the ACA we had one of the highest number of uninsured residents. Not sure where we rank now, but I'm sure we have come up a bit. Currently, for a family of five, if you make under $75K a year your kids can go on CHIPS. In a poor, low-wage state, that's tons of kids now covered.

The pharmaceutical industry has gotten off scot-free a few times. The biggest one was when W added Part D to Medicare but failed to put in any sort of price controls on pharmaceuticals, unlike Medicare's arrangements with doctors and hospitals. This one, though, is a blow to one drug company anyway. If I was in the position United is proposing, Enbrel would be off the table for discussion. Perhaps UHC owns stock in another company or two, or is otherwise in bed with the Humira/Cimzia/Stelara people.

Emerald, your governor was ushered out of Congress for ethics violations, and then the good citizens of Georgia elected his ass governor? And what did they expect????