There's an Enbrel club of sorts that helps pay for your medication. Are you on that? When you say "pharmacy plan" are you talking just drug coverage? Or full-on medical insurance?

Here's the link to the Enbrel Support Card.
http://www.enbrel.com/ENBREL-support-card-program.jspx

Thanks RC
Yes I get already Enbrel support. and that always covered my deduct. but now that they are going with a specialty Pharmacy it has to come out of my drug plan not medical. The Ins. send out Letters to everyone who self injects or is on any kind of drug that is classified now as a special med. Enbrel would help pay but not all of it and my out of Pocket would still be close to 4000. So this affects millions of people. it's sad really. I dont know if they sell it in Mexico or Canada. I would go get it there.

Very sad....My husband takes Enbrel for is psoriasis. We haven't heard of this happening - we're on BCBS so hopefully we won't have added out of pocket expenses for it. It's crazy expensive, but all "specialty" meds are.

Hugs. I hope you can figure something out. You might want to call Enbrel directly. From looking at their site they have several options to help with out of pocket expenses.

Pre existing conditions will no longer be allowed starting in January 2014. I know that doesn't help with the rest of this year but next year, they cannot deny you.

I had to get a clearance for flexeril...a simple muscle relaxant... . What next???

Big blue so sorry to hear that your insurance company is not covering what needs to be covered. I am certain they would not want to see me coming in with my huge bill for Rituxan $40,000.00 a year which is covered by Oxford. Guess I will be working forever. Sometimes the medication companies have assistance programs. Check with Enbrel and see what they can help you with and the arthritis foundation. I wish you luck.

Check with your state health insurance. In MA they will supplement the difference.

Cassue2u, I had trouble getting my flexeral too, so my doctor sent the script to Walmart, it is one of their $4 prescriptions. They don't even submit it to the insurance.

If you are trying to switch to better coverage they probably won't accept you if you have an RA diagnosis, although I'm sure they would be delighted to sell you WORSE coverage. Bcatz is right about 2014 and healthcare reform, but that is 10 1/2 months away. (Personally, I'm counting the days! Hope to find something cheaper.) I have a BCBS policy, and think they are trying to kill me, or at least find a reason to cancel my policy after some of the claims I've had this year.

You ask about going into remission and the stopping meds. I haven't tried it- no remission here- but the general consensus is that it isn't generally good to do. The meds have tamped down the fire, but haven't put it out, and it will flare up again.

Oh, and to answer your question about remission after stopping Enbrel, yes, I'm one of them!

I stopped in in December of last year and have not been back on it. I feel rA in two fingers - and have xrays scheduled in March. I think my full remission is ending though as one of the fingers feels gritty when I move it at times. I'm going to request a dmard for MILD RA only at this time. I'll have to get my liver checked a lot.

I'm sure your doc knows best. My doc said it's not good to go on and off Enbrel (I wanted to take it a few months, quit til I needed it, etc). When I go back on it, it will be a permanent change or until it is no longer effective. My dr. said the problem is that your body will develop antibodies to the Enbrel going on and off. Somehow, the immune system sees it that way versus going on it and staying on it.

Thanks for all the good advice. Im going for my yearly mri tomorrow. I went to see an agent who called bcbs and they said that i would be denied all drugs (biologics) that they would probably accept me but without the "specialty drugs". I am gettimg my last shipment tomorrow and have another month in the fridge, i'll just stretch it over the next 8 month until next year i guess. I do ok on pred just bad for the liver. Its really sad. Enbrel was a god send i could barely walk before and mtx wasnt working anymore either. Enbrel
Was the one that worked for me. Im still ok just the pain behind my knees which im going in for tomorrow too. Thanks again.
Bigi

I hate the specialty pharmacy feature that they've added to so many health insurance plans. It's now part of my insurance through work and I had to use it last month. My orthopedic prescribed a synvisc injection for my left knee to try to help with some of the bone degeneration I have. I had to pay for the synvisc through the specialty pharmacy & then they sent it to the doctor's office for me to get the injection done. I had to pay $1600 for the medicine and then another $85 for the doctors visit. A couple of years ago, I had the same injection in my left knee and insurance wasn't using specialty pharmacy then - the doctor's office provided the medicine - and my total cost for the injection was just $40 - the cost of an office visit. It's ridiculous the way they are killing us with medical costs.

You might also ask your doctor if he can get you a couple injections directly through Enbrel.

You know the saddest part - there are those who quit Enbrel for various reasons (not working, reaction, had to stop for whatever reason) and they still have a few sure-clicks in their refrig. :(....doing nothing, but there isn't anything one can do about it.

I feel your pain, though not as heavily. My husband and I had continued the health plan thru the union until Nov last year and then we went to Medicare w/supplemental policy from Kaiser. We saved $600 a month and we figured what the heck. I was used to paying $10 co-pay for any drug and nothing for labs (it was GOOD insurance) so it has been an eye opener for us. We still pay 10 for some rx's but the things like enbrel we will have to pick up 25% of the cost and that scares me. Being on a fixed income I can only hope I don't get put on any of those drugs for a long time! Right now mtx & meloxicam seem to be doing the trick and I am keeping my fingers crossed. The only bad thing there is now every time I get blood work its $30 and my doc wants me to get them every 2 weeks, squeak! I do wish you well and will keep hoping that you find a way around $4,000; I don't know too many people who can absorb costs like that. God bless you. Trish

Thanks again,
well I went to see my Rheumy"s PA and they did the MRI and then she gave me a shot ( sctuallt 2 to mumb it, ouch) in each Knee and today I feel so much better. They akso said that there isa an assistant
program that they want to see if they can enroll me. I told her I probably wont qualify b/c my Husband makes too much, but she said to fill it out anyway. If for some reason I would be denied (which they think I wont be ) then they"ll provide me the shots from the office at no cost. The Rep comes and drops of plenty of them and they would give them to me that way.
I thought I was going to cry, it was so nice of them. They know I was in remission and had seen my earlier days and they dont want me to quit Enbrel if it has helped me that much. I can wait til April. In March is when I get my last Shipment, so I'll see what happens. It is a shame what the Insurance company's are doing, and the sad thing is its all the RA meds (biologics) that are affected. I wonder what others too. Thanks so much I always love to come back to DS. You Guys are awsome.
Cheryl, I opted for the Arthroscopic Surgery a couple of Years ago and it was great, I was back on my feet in no time and the healing was really quick. He did say that there is no guarantee how long it would last, but if mine gets to bad again then I'll have it done again. It is probably cheaper than the shots, since your Insurance covers most of it or all of it. You all have a great Lent ( for all the Catholics out there).
Bigi