Friday, August 20, 2010

Enbrel: Currently Less Help, More Headache

I'm still trying to figure out how to pay for the Enbrel after getting charged $750 last time we went to the pharmacy (an amount we can not afford once, let alone every month). After many hours on the phone, there is good news and there is bad news.

The good news is that school is starting next week. (Wait....I take that back. School starting is not good news! What happened to my summer?!?!) That means that my new year of health insurance has been activated, giving me a new $5,000 cap to cover at least 50% of my prescriptions. So that means that of the $1,600 cost of Enbrel, at least 50% will be covered the next time I pick it up.

The bad news is that, even with my insurance, that still leaves me with a co-pay of about $800 that we can't afford this month any more than we could afford it last month. Not to mention, based on last year, we now know that my $5,000 cap for prescriptions will be reached way before the end of the year, meaning I can look forward to being in this same pickle again next year. But I guess we'll cross that bridge when we come to it.

In the meantime, the other good news is that the people at Enbrel Support have been very helpful (aside from having to re-explain my problem to each person I talked to and having to wait  a while for the right person to call me back). I can't re-activate my Enbrel Support Card until October, because I already reached their $4,000 cap in this six month period. However, they found another program that I might qualify for to assist me with my ridiculously large co-pay in the meantime. They are sending me the application for the program, and they said they would call me next week to follow-up and make sure I didn't need any more help.

But the other bad news is they said it would take 7-10 business days for the application to arrive.  And then I'll need to fill it out, send it, and get approved. And, if approved, the program will help me pay  for future Enbrel but they won't reimburse. Which is problematic, considering that I don't have any more Enbrel and I'm supposed to take a shot tomorrow. If I have to go without Enbrel for a week or two until we get this straightened out, it probably won't be pretty. And the timing totally blows. Did I mention school is starting next week? Crap.

I've called my rheumatologist to see if they can help me get some Enbrel for the next week or two until I get the paperwork for the co-pay assistance straightened out. Even if they can't give me any I'll need to talk to them anyways - I'm sure I'll need a refill on some pain meds if I have to cold turkey off the Enbrel tomorrow. ::sigh::


Skye said...

man this sucks :( just another reminder on what i'm going to have to deal with after i'm off my dads insur come decemeber... i just hope my work's health insurance is good enough arghhh. Goodluck i hope that paperwork gets done quickly for you, i went three weeks almost without enbrel and any other meds last month, it was complete hell.

Pochemuchka said...

Have you considered whether some of the new government-backed high risk insurance programs might make more sense for you than your school's program? The monthly premium and (probably) the deductible would be higher, but these programs usually don't have a cap on prescription benefits. See CoverColorado for one example.

~Mariah~ said...

SKYE: Don't worry - the people at Enbrel support are actually really helpful. You just have to stay on top of them. But yeah...figuring out this insurance stuff is like a full time job in and of itself.

JESSICA: CoverColorado is totally on the list of things to check out - my rheumatologist told me about it last time I was there. I'm only a student for one more semester, so I'll need a new plan come December, at least until we get married in May. Thanks for the advice!! I truly appreciate it.