New Here. Having difficulty getting Enbril Approved by Insurance

graygirl

Regular Member

Joined : Feb 2016

Posts : 26

Posted 2/16/2016 3:56 PM (GMT 0)

I have been on Plaquenil for 16 yrs and I now need stronger meds. MX was doing something weird to my heart so I'm trying to find another alternative. My insurance company has not approved Enbril, stating that I must try other options. Not sure which of the meds I should try. Rheumy states she will contact the insurance gain. I'm in a lot of pain.

Don_D

Veteran Member

Joined : May 2013

Posts : 549

Posted 2/16/2016 9:47 PM (GMT 0)

Hi, If you have been on methotrexate and plequenil I cant imagine they will deny you. MTX is the one that it seems most companies want to see not being effective enough before they will go ahead with the biologic class of drugs. Could be they may want you to try sulfasalazine as well but I would be willing to bet that your Doctor will get them to buy off on the Enbrel. Just might take a few days to get through the process.

I am sorry to hear you are suffering. I hope that you find relief and you are able to find a long term solution. Enbrel worked amazingly for me for about 12 years. It was pretty incredible. I hope that you get many more years than me from it. Hang in there and take care. -Don

celebrate life

Veteran Member

Joined : Dec 2014

Posts : 2112

Posted 2/17/2016 8:37 AM (GMT 0)

Hi Graygirl and welcome to the HW forum. The insurance doesn't like to approve these drugs because they are expensive and I have heard from my Dr that enbril wants you to have mtx in conjunction. Your rheumy might have better luck getting humira approved for use without mtx.
When you do get approval, the copay can be astounding. Be sure to check into the drug assistance program immediately so you can get most of you copay covered.
I hope it works for you as well as it did for me and Don.
Beth

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