Re: Cost of Enbrel With Insurance

[Guest guest]

My doctor is considering putting me on Enbrel. I am currently in the process of

getting Blue Cross Blue Shield Insurance through my employer. Does anyone know

if this insurance pays for Enbrel? I make quite a paltry salary and will not be

able afford it without some insurance help.

Best wishes to all,

Leonora

[Guest guest]

Dear Leonora,

I have a PPO with Blue Cross Blue Shield. Right now any injectable

medication is covered under my major medical part of my health plan. So I

have to pay 20% and they pick up the difference. I'm taking Humira now and

my copay for a month (2 shots) is $261 a month.

I would imagine you would have a similar program on your health plan. I

hope this helps. Sincerely, Fran

[Guest guest]

Hi lenora,

I have bluecross blueshield of Ma. and it is covered on my

insurance without prior approval. On my plan there is a $25.00 copay

a month or $50.00 for 3 month supply through the mail order. I found

out all my info before I started Enbrel at the www.bluecrossma.com

They have a section on which drugs are approved and which need prior

approval. Also ones not covered at all(look for " Pharmacy information

and medication search " on left side of home page) .My Bluecross works

on a 3 tier system for the copays based on generic or brand name

drugs. I'm not sure if all Bluecross insurances work the same. But

when you know what your company is getting you can go to Bluecross

site for your state you should find some answers. I hope this helps

you.

Steve

[Guest guest]

Leonora,

I have Blue Cross of California, and Enbrel is not on their standard

formulary list. They (BC of CA) do have a form online though that one

can bring to their doctor to authorize Enbrel coverage if their

diagnosis is PA (if it's not PA then they require you to have tried

other DMARDs first). As Enbrel is the only/one of the few medications

that is FDA approved for treating PA, I had no problems getting

approved for coverage. My doctor told me that with most PA patients

he is able to get authorization, although occasionally has to fight

to get coverage. So just have your doctor submit the prior

authorization form for your BC/BS company if needed and be prepared

if it takes a little more work to get it approved.

Good luck.

Harry

[Guest guest]

Each state Blue Cross plan is different. When I was on Enbrel, I had Blue Cross

of Lousiana and only had to pay my co-pay for non-generic prescriptions, which

was $20.00. Which considiering how much the Enbrel costs, was not that bad.

Lori