Enbrel Co-Pay Card

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I'll be starting Enbrel soon - depending on if I qualify for the copay card program Enbrel has. I'm wondering if any of you have any experience with using this copay card?

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  • Posted

    Hello Justgettinby,

    I began Enbrel on November 16, 2016. My insurance covers most of the cost of Enbrel and the support card covers the remaining cost. So far I have not had to pay anything for Enbrel, not sure if this will change or not.

    Don

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    • Posted

      Thanks, thats helpful to know. The process of getting the card is getting to be long. I've been waiting 3 weeks and called last week for an update and was told they are now waiting on a prior authorization form from my rheum. He only works 2 weeks a month, so it's going to be another week to get that done. Lots of red tape, I hope it works!

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    • Posted

      Hello again. When I applied for the Enbrel support card I called 888-4ENBREL and they took care of collecting the information over the phone and applied the support card number to my account automatically. I had the card even before my Enbrel prescription was approved by the insurance company. I have to get my Enbrel through Accredo Specialty Pharmacy. The is per insurance company requirements.

      Of all the specialties of medicine, one would think the rheumatologist would allow new patients to come in a begin treatment immediately. When I was first diagnosed with RA, I was referred to a rheumatologist. I believe is was in April of that year. The first appointment he had available was in late June. I thought to myself "this doctor has no clue what pain level I am at." So I found another rheumatologist and had an appointment the next week. Things did not work out with this rheumatologist, so I have been with the doctor I was scheduled to see first, I have been with my current rheumatologist since January of 2016.

      I do not know if there are other rheumatologists near where you live, but when I am hurting, a part-time rheumatologist would not be good enough, especially if I had a flair in RA at the beginning of his two weeks off. The next time you have an appointment, or even when someone is in the office, ask if the office can give you samples of Enbrel until the approval process has been completed. The process with my insurance took three weeks, initially my doctor's office gave me two sample injectors, I had to ask for another one before I received my prescription in the mail the day I needed to inject. Enbrel should be injected on the same day each week. So it took four weeks before I was receiving regular shipments containing four SureClick injectors of medication.

      Hang in there, I know from personal experience how painful RA can be. The sad part is that my wife does not understand what it feels like and sometimes she just gets frustrated with me. Oh well, at least my children understand part of what I am going through and they are a bit more helpful than other family members.

      One of the nicest parts of this forum is that people understand since they too are experiencing it as well.

      Take care, let me know how it goes for you.

      Don

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    • Posted

      Yes, I've thought about switching to another rheumatologist, but I really like this one and I only have to travel 12 miles to his office. If I switch it will mean a minimum of 80 miles to one. I will most likely have to do this because this one is retiring this summer, and they only have 1 other who is also only there part time. They have been looking for a full time one for a while now, but they are hard to come by. I've gone to the other one, and she was so abbrasive and it just wasn't a good fit for me. My dr also makes sure I always have a prescription for prednisone if things should go seriously south for me while he is not in the office, so I'm ok with that. They do not keep samples of Enbrel at this office, so thats out. I'm on MTX injections already, which help, but not completely - which is why the Enbrel is getting added in. I'll just wait patiently while the red tape clears.. lol  

      Oh, and I totally get the spouse not completely understanding. Mine pretty much tries, but he thinks I have to "toughen up" and work out more. I try not to complain, but it should be pretty clear to him when I can hardly walk across the floor without wincing, and seeing when my wrist is swollen and sore... but he doesn't live in my body, so I have to try to remember that he can't know how I feel... Its very tough on a relationship for sure. 

      Thank you for your response!

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    • Posted

      I understand the hassles about switching rheumatologists. An 80 mile drive is a bit much to see a doctor, even a rheumatologist. Hopefully another rheumatologist will move in and take over the practice where you currently go to see your doctor. I know Prednisone well. Before beginning MTX, Prednisone was my daily friend. Prednisone worked when nothing else did. Too bad Prednisone has side-effects of its own, if it did not 50 mg every day would make me feel quite good with no pain and no inflammation.

      Yes, the whole spouse thing. My wife was upset with me after my surgery because I would not wash out the pots and pans I used for making a meal. I would just put them in the sick and fill them with hot water. She ripped me a new belly button over it one day. I exploded because every movable joint in my body was in an extreme state of inflammation and pain after my surgery that I could barely move or even dress myself. I basically told her that once every joint in my body quit hurting and I could move without pain, I would once again wash the pots and pans I used. Her attitude changed a little bit after that. I do not think they will ever understand it unless they experience the pain, which of course we would not wish on anybody.

      What's your story? Is it rheumatoid arthritis or one of the many other choices none of us has chosen?

      Don

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    • Posted

      My story? I guess it would be the for sure unchosen RA. It runs deep in my family. I have 9 brothers and sisters and 4 of them have RA. Currently I am the only one who chooses to to treat it. The rest are afraid of side effects - at least thats what they say. I believe that it is because they will have to give up some bad habits... smoking, and drinking. I myself am not a smoker and have lived a very healthy lifestyle. I was a runner (working on getting back at it now), and lifted weights a few times a week to strengthen my running. I also have always been a firm believer in eating right, and getting enough sleep. So, I'm more than a little p*ssed off that I got this disease. Its all genetic in my case. I also have Hashimoto's (thyroid autoimmune disease), and eczema... triple autoimmune disease girl here :-(  Fatigue and I are pretty much best friends, but I really do try to work through it all and be as functional as I can be. Thankfully I do not have to get up early for a job anymore as we are self employed and work from home. The bad part of that is insurance. I live in the USA, so when your self employed you get hit hard with high rates, high deductibles, and nothing is covered so its always a fight. I'm actually a nurse and have considered finding a part time job with benefits just to have better insurance, but the stress that would bring would mean being in a constant flare so I don't know if it would be worth it. All in all life is very good, but some days I struggle to feel that the glass is half full and I would guess this is the case with most of us RA folks. 

      Yes, prednisone would be my drug of choice if it wasn't so bad for you to be on long term. I feel like a million bucks with energy and hardly any pain when I'm on it. Its as amazing as it is dangerous.. which sucks!

      Wishing you pain free days and an understanding wife Don!

      Take care :-)

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    • Posted

      Wow, what a story yours is. I am one of four children in my family. Only one brother has arthritis symptoms, but he has never been to a rheumatologist, so I am not sure if his is rheumatoid or osteoarthritis. Like you, I have always tried eating healthy, never been a smoker, never been a consumer of alcohol, never done any street or recreational drugs. I love to stay active. In the summer it is gardening, was biking, was beekeeping for three years, was rollerblading, wanting to try kayaking and rowing (I think it is called the crewing), the long, skinny boats where five or more people sit on top and work together to make the boat move forward. In the winter I enjoy cross-country skiing and snowshoeing, so yes, I was a bit upset with the diagnosis of rheumatoid arthritis. Now that I have rather severe RA, I am on Methotrexate 10 mg injection once a week along with Enbrel 50 mg injection once a week. These two medications allow me to continue to enjoy life at this time. I went cross-country skiing on December 23 and 24 and thoroughly enjoyed it. When the weather warms up, I plan to begin rollerblading again. I will do these activities as long as my body is able to enjoy them without too much pain. If I did not inject both of the meds, I would be completely disabled is less than one month, that is how severe the RA is attacking my body. I know this because I was off all meds in October of last year for a surgery unlrelated to RA. Twelve days after stopping all meds, which was two days after surgery, my body almost seized up on me. If a joint could move in early October, it could not in late October, even my jaw was being affected. 

      I am a bit concerned about the possibility of side-effects, I would be lying if I said I were not, however, the meds were able to restore my life and my enjoyment of life. Since I am not able to ride a bike anymore because of wrist and hand pain, I will have to be content rollerblading, until I am able to afford a recumbent trike. Riding one of these would be a lot of fun as the pressure point pain of riding a bike would not be experienced.

      Yes, Prednisone, both a friend and an enemy at the same time, but a miracle drug.

      I also enjoy studying Braile in order to become a Certified Braille Transcriber. But this is on hold due to wrist pain and the fact that I am also attending school to become a Certified Medical Assistant. My classes begin on January 24, Monday through Thursday evenings from 5:30 pm until 10:00 pm. Then a six weeks, thirty hours each week externship.

      So being totally physically exhausted is a constant companion as well. I was a hobby beekeeper for three yeas because I love raw local honey. Honey does wonders on allergies and helps to keep me healthy too. However, last September 30, I became allergic to honeybee stings when one of my bees stung my right hand. So I am waiting to see if the allergy injections do any good before actively keeping bees once again.

      Take care, let me know how things progress.

      Don

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  • Posted

    I take Enbrel and it took about 3 weeks to get it. I called everyday and sometimes twice a day. It did not speed things up though. I got Enbrel free for 6 months, now I pay $10 a month. The best thing I can tell you is to FOLLOW UP. You wouldn't believe how many times they don't do what they are supposed to do. I also call my doctor's office. I had a regular doctor taking care of me until my family raised heck that I go to a rheumy. closest one is 100 miles away and I don't really trust her but they are hard to get into, 3 or 4 month wait. I would rather just go back to my regular doctor I was doing fine with him and even the rheumy said he did everything right. The one thing I don't like about rhuemy's is they want to stick you on prednisone right away. They don't believe in pain pills and to me that is cruel. I just posted a post on prednisone and how it doesn't really help me, even 50 mgs. As far as getting along with the Enbrel people, I have no problem. They call me when it's time for a refill which is great, but they take a loooooong time on the phone. If you miss their call, you'll have to make sure you call them back asap. They will also send you a box of alcohol swabs, a sharp's container and a bag for transporting your Enbrel if you take a trip. They also have a nurse that will call you every few months to see how you are doing if you want that. Be aware this is another loooooong phone call. 

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    • Posted

      Hello river22,

      Everyone responds differently to medications, as I am sure you are aware. For me, it also took a while to get in to see a "rheumy" as you put it. I think the rheumy's should always make room for a new patient since RA for me was almost debilitating before beginning Methotrexate in January 2016 and Enbrel since mid-November of last year. My experience before Methotrexate however has pure misery. No pain medication worked for me. This includes Tylenol 1000 mg, ibuprofen 600 mg, Aleve and even the stronger prescription Aleve. None of these even attempted to take the edge off the pain either. The only medication that worked for me prior to the big guns was Prednisone. Prednisone took me from hardly being able to move and not being able to put my own socks and shoes on to "WOW, I have my life back" in about four hours to maybe the next morning at the latest. Too bad Prednisone has its' own batch of somewhat potentially serious side-effects. Fifty mgs of Prednisone every day and I would be like a new person, but the long-term results could be worse than the RA.

      I still have a bit of pain, especially lower arms near my wrists, as well as wrists, hands, fingers, ankles and sometimes feet near my toes are swollen. The longer I am on MTX and Enbrel, these becomes less and less of an issue as times go by. Because of these meds, I was still able to enjoy cross-country skiing twice in December of last year, would have gone more often, but this is the second winter in Michigan with very little snowfall. Will be rollerblading as soon as the weather warms up and the rain doesn't happen so much.

      My Enbrel comes through Accredo, and my experience with them is very impressive. Yes, the conversations can be lengthy, but they are very good at working with my rheumy for prescription refills and calling me every month when it is time to coordinate a new shipment of meds.

      Take care and stay healthy,

      Don

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  • Posted

       I am waiting for approval for Cimzia and it is also taking 3 to 4 wks now.   I also want to apply for the copay card.  I had one for humira and I don't recall it being a long wait anymore but I may be incorrect.  I had bad reaction to it

       I am also 'in the club' of multiple autoimmune diseases.  I have 3--vitiligo, crohn's and now inflamm. arthritis.  So we are trying to get one biologic that works with both and for both docs to agree on which to try.   They differed on which to try next so Cimzia it is   Now having 3 autoimmune I become fearful of what the next one will be that comes along

       I hope you get your co-pay approved soon.  Makes a huge difference to get that help financially   Good luck!

     

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  • Posted

    Well, just an update.. I found out yesterday that I don't qualify for the Enbrel copay card. I don't quite understand it all, but they say it's because my insurance requires me to pay 100% of it up until I reach the deductible of $7150, then I have to pay 30%. She tried to explain to me about how the insurance pays for part and they pay for the rest up to a certain amount a year, but my insurance requires me to pay 100%. I also had to get a prior authorization from the dr, but I have no idea why since it won't be covered no matter what.

    Right now I have decided to just stay on the MTX and hope it starts working better. I can't tolerate a higher dose and right now it's not looking good with a pretty horrible flare setting in... oh well, life without remission goes on I guess.

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    • Posted

      Well, what a bummer. I guess I do not understand how it all works either, but first of all, I do not understand how this medication, Enbrel, can be so expensive. But I think Humira may even be more expensive than Enbrel. 

      How much MTX are you on? Do you take the pill form or give injections? My body did not tolerate the pill form very well at all. One dose of 10 mg put me in pain for two or three days. I have been on as much as 20 mg by injection once each week but blood test came back with less than desirable results. I am now on 10 mg injections. Even with MTX and Enbrel, stiffness in hands seems to be an almost constant companion, but the pain in my wrists and hands finally began decreasing this weekend without much use of ibuprofen. 

      I need to get back to eating a salad every day and getting back to a more vegetarian diet. With working full-time, being in school full-time for medical assisting certification classes, and then spending alomost all of my free time doing homework, trying to find the time to prepare healthy food is not an easy task. I need to find time for exercising as well, but this too is difficult to fit in the schedule, especially if I want to go rollerblading or walking outside as the spring rainy season has arrived in Michigan.

      Don

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    • Posted

      Yes, the cost of these meds is absolutely rediculous! Drug companies are out of control here in the US. Its pretty sad to me that the meds that actually help this disease are pretty much impossible for some of us to get on due to cost. If they (powers that be - government or whoever) really wanted to save money - and HELP us, they would do something about it. I'm really upset right now, so I probably shouldn't even respond, but I just don't get it. In other countries, people with RA get put on a biologic right away because it friggin helps!! Ugh!!

      To answer your questions, I am currently on 20mg a week of MTX - injectable. I never did the pills because I have an extremely sensitive gut and didn't want to risk the side effects. I was supposed to be bumped up to 25 mg, but I can't tolerate the side effects at that dose. I feel hungover with nausea, chills, headache, extreme fatigue for 2-3 days. About the time I feel better its time for another shot - which is so anxiety producing anymore I almost vomit before I do the shot. I can barely tolerate 20 mg, but 2 days of being "hungover" is better than 3 I guess. I was so hoping to get on the Enbrel so that I could reduce the dose of MTX down to 10. 

      I eat a pretty clean diet, and I exercise at least 3 times a week. I used to be a 10K runner, now I can barely do 2-3 miles (on a good day because my damn feet are so affected). I try to keep pluggin away, but some days its dang hard. My left wrist has grown a couple nodules now and some nights hurts so bad I can't sleep. I'm in MN and the weather here has been wet and cold - which I've found is the absolute worst for me. I'm hoping this week it dries out a bit.

      Right now I'm debating if I want to pay out of pocket for the Enbrel to see if it will help. I will be paying up to $7150 to meet my deductible before the insurance will cover it. My husband wants me to try. I'm sure he's getting quite sick of his wife being such an invalid. We celebrate our 28th anniversary this weekend and I'm so thankful he's still here and says he will be til the end. He may not understand all the time, but he really does try. I'm not easy to live with right now with this never ending flare :-(

       

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    • Posted

         I am so sorry you got such awful news about the Enbrel cost not being covered at this time.    Has any other DMARD drug been tried in conjunction with the MTX--maybe that could help give some relief.  But if  you have a bad tolerance for p.o meds perhaps that would not be helpful.   I of course don't know your financial situation but if your husband wants you to try it and pay I think that you should consider it.  It may or may not work for you but I think you should give it a chance.  MTX doesn't seem to be doing you much good on it's own

         I am in the US also (MA) so I can relate to your weather problem.   I think you may be wrong about other countries paying almost immed for biologics.  It seems like many people have to give months of trials on the DMARD drugs a chance  before approval of the new biologics.  Maybe others here are able to correct me on that assumption

       And time and distance to finally get to see a rheumatologist seems much worse than where I live.  Course being in the Boston area--a hub for medical docs I had no problem finding a rheum. closeby and easy to get an appt quickly.  But I certainly understand your frustration.   When my husband retires we will no longer get the copay card approved as we will be on medicare. Thats in a year or less.  I got quite sick with Humira and now I will be trying Cimzia and who knows if I tolerate that.  I am sensitive to many medications        I wish you the very best--relief from the constant pain.   Bless you!

         Gloria

       

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    • Posted

      Yes, I was on Plaquinel alone for the first 5 months after diagnosis (last year) and needed prednisone all the time because it just didn't help my symptoms. Then the MTX was added and I was on both of those for the next 4-5 months. I chose to d/c the Plaquinel because I felt it wasn't doing anything for me, and why take a drug that holds so many possible side effects if it isn't helping? Yes, I know that biologics hold many side effects too. When my rheumatologist told me he could almost guarantee remission, I got excited about the possibility. 

      Maybe your right about the med thing with those in other countries, it just seems like all the forums I've been on where there are people around the globe, many got put on a biologic right away. 

      Right now my dr is only 12 miles away, but he is only part time - as is the other one - and they are both retiring in June. They are trying to find a permanent replacement, but so far they haven't had any luck. This means I'll have to travel at least 50 miles to see one. I'm ok with that as long as I find a good one :-) 

      After thinking long and hard about this, I've decided that I'm not going to go on the Enbrel. It isn't even cost, although I admit that is part of it. I just feel like maybe right now the weather is making things worse for me, and maybe I need to clean up my diet some too. I feel way better when the sun is shining and I can get outside and clear the cob webs from my body from the long winter. My dr also said taking prednisone occasionally for short amounts of time won't hurt me either and I get a great response from just 10 mgs - literally within 5 hours! So for now I'm going to just simmer... I know if things get worse, my husband and I have decided that I will then go ahead with the Enbrel. Thank God I have that option. 

      Thank you for your kind response and I wish you well too :-)

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    • Posted

         I do hope it works for you without the Enbrel and if not go ahead and give it a try.   I am waiting for better weather too   Been pretty raw/ miserable the past several days but hopefully spring is right around the corner which will lift spirits  : )
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