Drug progression

February 10, 2003

It was recently diagnosed that my PA flare was not just seasonal but a

progression of the disease. My RD said he would like me on Enbrel but

first I had to fail on two other drugs for insurance to pay for

Enbrel. He put me back on Mobic and started Azulfidine and said it

would be atleast 2 mo for the Azulfidine to work. Then if that failed

he would try MTX. So I am looking at several months of pain and also

hoping these drugs fail so I can take Enbrel. It's crazy! The

insurance company is determining my treatment, not my doctor. My RD

" should " be able to prescribe a treatment for his 5 year patient. I

trust my doctor and have always received great care and attention from

him. However, some computer, fed my numbers will decide on my

treatment program. I know there's little I can do but ride out the

next couple of months. I just wanted to explain my frustration about

paying such high premiums and having such little control over my

treatment. Thanks for letting me vent.

Savannah

February 11, 2003

Hi, I fought that war this summer and won. My rheumy sent a letter

to the insurance company and I hand delivered a copy of it to the HR

Rep. at work along with harassing him everyday until I got what I

needed. They had changes in the policy stating they would not cover

any injectables not even insulin. Myself and one other employee of

this large company are taking Enbrel and were on it when they made

the changes. This stopped our Enbrel temporarily. Rheumy wrote in

my letter that I had tried and failed all the drugs (naming every

drug on their approved formulary list -- even ones I had not ever

tried) and that Enbrel had been sucessful for me. I took the letter

along with an article about Enbrel being the first and only drug

approved by the FDA for PA to them and copies were sent to everyone

concerned. I also wrote a letter stating how Enbrel had helped me

and that without it I would end up crippled by this disease, that it

was slowing the progression when all else had failed. I have Enbrel

again since they changed the policy again because of this. That war

began August 1st. I have just last week received the insurance

booklet telling us what that new plan will cover. I was told we

would get new books soon in about 3 weeks--it took 6 months. In the

new book it states they will cover injectables but NOT BIOLOGICALS.

I'm probably going to have to fight the war again this summer at the

end of their fiscal year, as I was approved for a year. You can go

to the Enbrel site for a copy of the article I gave them. It was

very helpful in getting the help I needed. Also, an Enbrel rep will

talk with your insurance company to help you get and or keep the

drug. Cassie

February 11, 2003

Dear Savannah - I too had to go through the rigamarole of 3 NSAIDS failing to

get Celebrex and then Enbrel was given to me with no trouble at all. The Dr

actually had to change his diagnosis to osteo before the insurance would give it

to me. So it sounds like many of the insurance companies insist on trying the

less expensive drugs first. J

[ ] Drug progression