Rheumatoid Arthritis Support Group

Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...

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Waiting on insurance approval

MommaAshley
MommaAshley
I have had RA for about 2 years. Have tried NSAIDS, plaquenil, prednisone and methotrexate. Did pretty good over the summer, but had a major flare as these hurricanes moved thru and never really returned to my baseline. Now I am playing the insurance game trying to get enbrel approved. It's going on 2 weeks now. My doctor encouraged me to call the insurance company as well to help push to the next step after the enbrel was denied the first time. The customer service rep had the nerve to ask me "uh...what is RA?" Then i had to spell the name of the medication 3 times before she got it. Now my doctor has to call the "specialty pharmacy" and inform them of all the meds that failed. Then a board will decide if I can receive the medication. Meanwhile I am in so much pain I am taking a narcotic almost daily and I HATE HATE HATE that. I work for a big health care company, I pay $680 dollars a month for a family plan insurance coverage. I expect a little more out of the company. I am so frustrated with this. I pray that we are able to get something going that works...my poor feet feel so broken and I am tired of living my life around the pain.
deleted_user
deleted_user
I hear you. I've just started the Enbrel process w my insurance company. We'll see how it goes. But they tell me and my doc what to use for my asthma, even though what they'll pay for doesn't work for me. And what works for me, they won't pay for. I had to stop Arava due to the side effect of hypertension. At the moment I'm subsisting on prednisone and pain medication. I've "failed" plaquenil, ridaura, MTX.
I will be hoping and praying hat something positive comes through for you quickly. Keep us updated.
altoclef
altoclef
It is pretty absurd. My doc tried to get approval for Enbrel for me this summer. It took Blue Cross a month to decide that I couldn't have Enbrel but COULD have Humira. The specialty pharmacy left a message on my home phone Friday, I called back Monday, and the insurance co. had switched pharmacies over the weekend!

Humira & I didn't get along so well, so now we're back to square one asking for Enbrel again. It's just ridiculous. My local pharmacy does have Enbrel in stock, but no no no they can't sell it to me, it has to come overnight delivery from somewhere out of state.

Meantime, some committee is meeting to see if you are in bad enough shape to warrant spending the money on Enbrel for you. They, of course, are the experts. Not.
deleted_user
deleted_user
pharmaceutical companies offer assst programs for these high price R.A. drugs and other meds. before my insuance kicked in, the company would send 3 month supply of med. at my Rheumies office. Would pick the med. up there. Hope this is helpful for you. Your Doctor should be well aware of this. Just ask.
best wishes.
deleted_user
deleted_user
my insurance company has ultimately paid for every medication my doctor has asked for, but it hasn't been easy. sometimes it's taken a month or two to get approval, and sometimes i've had to jump through hoops to get the meds. i've tried enbrel, humira, remicade, and orencia, and now am off the biologics and just taking arava. i also tried methotrexate and sulfasalazine, so i've had a bit of experience with all the different kinds of meds. right now the insurance is pretty happy with the relatively cheap arava, but i did have to get a pregnancy test before they'd let me have it.

in other words, insurance companies are jerks. their goal is to make money off of you, and paying for every expensive medicine that your doctor orders doesn't make money for them, so their first step is always to see if they can get the same result from a cheaper medication. i hope you get approval soon.
MommaAshley
MommaAshley
It's a shame what they put us thru. I am on hold with the insurance company now. Now they are saying they have no prescription for the enbrel and that it does not need pre approval. What??? I so confused! So I am calling the doctor back to see if they have any information for me. I really want this taken care of or at least in process before the holiday. But Oh well, it is what it is. Janebee I did ask my doctor about what you said and she did not want to get me started on something that there is a chance I wouldnt be able to continue on due to insurance coverage. :o(
altoclef
altoclef
When you do get approval, immediately go to the drug company's website and sign up for their patient assistance program. The co-pays on the biologics are usually several hundred dollars per month, but the manufacturers can and will help with that. Have that in place before you arrange to have the meds sent to you.