Anthem BCBS and Enbrel coverage

** Originally posted by MCorcione **

The bank that I work for merged with a larger bank and we now have Anthem BCBS. I went to pick up my Enbrel prescription today and the pharmacist told me that Anthem was not paying for it. I called Anthem and they told me they do not cover Enbrel.

I was wondering if anyone on this forum has Anthem and whether or not they have the same problem.

Thank you.

Report post

2 replies. Join the discussion

** Originally posted by BeadAngelFlakes **

The only advice I can offer is I know if you were covered for Enbril on your previous insurance sometimes you can have a rx granfathered in I know BS will cover Humira after having been diagnosed with P after one year. So, I would call BCBS pharm services and ask that your Enbril be granfathered in that you have been on it for how ever long it has been and it was covered they will more then likley ask for proof you can send it to them or have the pharm that you used call them. I hope this helps. I wish you the best I know how frustrating it can be to get things covered hang in there and fight them for it.

Report post

** Originally posted by MikeK **

Hi MCorcione,

Welcome to the board. :cool: Nice to meet you. I'm sorry that this has happened to you. :( (Sigh)

I agree with BeadAngel Flakes. Since Enbrel was covered under your old policy, it should be grandfathered into the new policy. In addition to talking to BCBS, you might want to talk to you HR department or your benefits' administrator. (It's possible that you might be covered if you use a mail order pharmacy.)

Also, first thing tomorrow morning, please give the NPF a call. They have an insurance advocacy department that goes to bat for people who are having insurance issues. Here's a link to a description of their service: http://www.psoriasis.org/advocacy/assistance/insurance/index.php and here's a link to their contact information: http://www.psoriasis.org/contact/.

Please give Enbrel's customer assistance hotline -- Enliven Services -- a call. Their number is: 1-888-4ENBREL (1-888-436-2735). According to their website, their insurance specialists:

can assist you with coverage issues related to ENBREL. Insurance specialists can contact your health insurance company to verify your benefits and determine whether ENBREL is covered by your health plan. In addition, they monitor health insurance company coverage policies and can assist in resolving denied claims.

Source: http://www.enlivenservices.com/pso/ongoingsupport/insurance/#q1.

If necessary, file a complaint with your state's insurance deparment or commissioner.

I hope this helps.

Good luck.

Keep us posted.

Mike

Report post

This discussion is closed to replies. We close all discussions after 90 days.

If there's something you'd like to discuss, click below to start a new discussion.

Things you can do

Support the National Psoriasis Foundation

Help the National Psoriasis Foundation reach its goals and support people like yourself by making a donation today.

Donate to the National Psoriasis Foundation

Discussion topics

Additional resources

Community leaders