Re: Enbrel, MTX, Insurance

February 20, 2006

Many thanks for the kind responses!

, thanks for the advice regarding the plasma. I did have to donate some

blood prior to my major gynecological surgery back in 1991, so I sort of assumed

I would have to do the same for the hip surgery as well, but do you know how

much they need? 4 units? 6 ? 8?

Regarding the Enbrel, I wonder if we waited too long to start it for it to be

effective. I started the Methotrexate right after being diagnosed with PA in

2000. Started at 5 mg and quicky titrated up to 25 mg orally each week. My

current rheumatologist was worried about potential liver effects, since I've

been on it so long, and wanted to decrease the MTX dose and start the Enbrel.

Only been able to decrease the MTX dose to 20 mg so far, and the Enbrel is 50 mg

weekly. I've been on the Enbrel nearly a year now. Recently, my limp is

horrible, one leg is shorter than the other since I've lost so much bone in the

hip, and my sciatica on that side is just killing me. My hands/wrists are

showing some inflammatory changes now (decreased grip strength, increased

dropping things, and increased stiffness and aching, along with numbness and

tingling in the fingers in the ams from carpal tunnel AND ulnar/radial nerve

entrapment.) and my feet are in bad shape as well (erosions, spurs, pinched

nerves, you name it.) I really think I need to either go back to 25 mg a week

orally on the MTX, and maybe go off the Enrel and either increase the MTX to an

injectable dose or try something else. My white count is usually around 11,000

with intermittent spikes to as high as 22,000; my CRP is 18.5 and rising, and my

sed rate is slowly creeping up as well, so obviously SOMETHING needs to be done.

I'm also experiencing increasing fatigue (I get home from work about 5-6 PM each

nite, and by 8 PM I am struggling to stay awake.) They cut my Physical Therapy

sessions short this morning due to the fact I was in such pain. (Unfortunately,

I don't see the rheumatologist till NEXT Monday.....at which time I will BEG for

a nerve block or two, LOL. Until then I will just have to do what I've been

doing in order to function lately, take an extra 600-800 mg of Motrin on top of

the 1500 mg Aleve daily I already take, and take a couple of Ultracets at

bedtime in order to get SOME sleep.

Jayson, my employer is a small pediatric practice. They provide us with the

option to have Humana Choice Care health insurance, and I really wish they would

offer us some other options to choose from, as I don't like this particular

insurance that much. (It's better than no insurance at all, but compared to the

BCBS HMO IL insurance plan I had working for the hospital before my arthritis

got too bad to do hospital nursing anymore, Humana really sucks.) I pay almost

$600 per paycheck for family insurance, there is a $2000 individual deductible,

$6000 family deductible, and 80/20 coverage thereafter. The prescription plan is

your basic $10 Level I, $30 Level 2, $50 Level 3, and 25% Level 4 (which

includes ALL injectable medications of any type....insulin, Humira, Remicade,

ANYTHING.) Humana also is a bear if you are on ANYTHING but Level One

medications; I have had severe asthma and allergies for YEARS and have been on

EVERYTHING (Claritin, Hismanal, Seldane, Zyrtec, etc.) It was

found during a period when my asthma was poorly controlled that I had " silent "

GI reflux contributing to the asthma exacerbations; they started me out on

Omeprazole which didn't work and then tried Prevacid, which worked until I

started taking the Aleve, and Methotrexate. Currently I am on a medication

regimen for that that has been working VERY well to control things: Protonix for

the GI Reflux, and for the asthma/allergies Advair, Albuterol MDI or Xopenex

nebulizer as needed, Allegra-D, either Nasonex or Flovent (every few months I

switch off from one to the other as my nasal membranes seem to develop a

tolerance and they seem less effective after awhile), and Patanol eye drops.

(Let me say here that it is a REAL balancing act, trying to juggle the drying

effect of the Patanol and antihistamines for the allergies with the Systane

lubricating eyedrops for the Sjogrens!) Anyway, Humana insists that every few

months my doctors have to call and fill out and send them all this

paperwork saying yes, I have tried the Claritin, and nasal sprays, and the

Omeprazole and whatnot, and yes I really DO NEED the Protonix and Allegra-D, or

else they refuse to pay for those prescriptions which they consider to be Level

3 and make me pay the entire price myself. And they really drag their feet once

they DO get the paperwork from the doctors as well.

It's really irritating. My dh has temporal lobe (complex partial) epilepsy

which he developed after being struck by a car while crossing the street. He has

a vagal nerve stimulator, and is on three different anticonvulsants. Two of his

medications are considered Level 3 by Humana (Keppra and Carbatrol, which is a

long acting form of Tegretol. Regular Tegretol doesn't work on him, because he

forgets to take the afternoon dose and his levels get too low and he seizes.)

and one is a Level 2 (Topamax). He's had this for 8 years now, and Humana is

ALWAYS sending us letters saying: " Did you know that Dilantin is cheaper? Ask

your doc about switching to Dilantin. " Well, he doesn't respond well to

Dilantin, he's either seizing nonstop, or has symptoms of toxicity with it

(vomiting, slurred speech, ataxia, drooling). And he's allergic to Gabapentin

(Neurontin); he broke out in a rash on it. I tell you, I just know they're

eventually going to pull the same thing as they did with my meds

above, tell us the doctor has to call or write every few months to authorize

his anticonvulsants or they won't pay, and those meds are approximately $400 a

month EACH. There is no way I could afford that out of pocket, and if he gets

injured permanently from seizing because they won't pay for his meds (and that

COULD happen, because my doctor sent the authorization form to Humana a month

ago and they STILL haven't OK'd my Allegra and Protonix yet. Luckily I can get

Allegra samples at work, but my stomach is really starting to act up without the

Protonix; I keep wondering when or if I'm eventually going to get a GI bleed out

of this.) I will be REALLY really upset.

February 21, 2006

Wanda,

Your insurance sounds EXACTLY like mine. I'm on PacifiCare in Washington. Same

copays for meds as you, no injectables, the works. Isn't amazing that we both

work for medically oriented places and get crappy insurance? The irony does

not escape me. Anyway. Yes, I have to jump through all of the same hoops with

paperworks, etc. The one thing that may be different with our insurances is

that I've talked to my insurance company and supposedly they cover infusions

even though they don't cover injectables. ARG! >:-(

Jayson

Re: [ ] Enbrel, MTX, Insurance

Many thanks for the kind responses!

, thanks for the advice regarding the plasma. I did have to donate

some blood prior to my major gynecological surgery back in 1991, so I sort of

assumed I would have to do the same for the hip surgery as well, but do you know

how much they need? 4 units? 6 ? 8?

Regarding the Enbrel, I wonder if we waited too long to start it for it to

be effective. I started the Methotrexate right after being diagnosed with PA in