Enbrel Coverage by Insurance Carriers

** Originally posted by drbotto **

Does anyone know if Enbrel injections are covered by Aetna? :)

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5 replies. Join the discussion

** Originally posted by Allie **

They covered mine with slim to no argument based on how severe I was at the time of initial prescription & the fact I was a newlywed intending on having children in the next few years.

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** Originally posted by MikeK **

Hi Dom,

Welcome to the Board. :cool: Nice to meet you. I think that it depends on the plan. I just came from Aetna's website. It appears that they have more then one drug plan and that some of them appear to cover Enbrel and some of them require "a medical exception" ( whatever that's supposed to mean!?! :confused: ) before Enbrel can be covered. The only thing that I can suggest is that you go their website ( here's a link to it: http://www.aetna.com/formulary/search.jsp ) and select your drug plan and do a search to see if Enbrel is covered.

Also, the NPF has an insurance advocacy service that goes to bat for people who are having insurance issues. You might want to contact them, if Aetna denies coverage for Enbrel. Here's a link to the NPF's 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/.

I hope this helps.

Good luck. Let us know if you have any other questions and please keep us posted.

Mike

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** Originally posted by SCCatman **

I think medical execption means you have to try and fail with other meds like mtx first.
I think a good derm can aruge around that.
My derm has someone whos job is to fight insurance co. for enbrel coverage. He says he has had 100% success at getting coverage.
Dennis

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** Originally posted by RichJ **

hi dom,
sorry i can't help much but welcome to the p family. you have met some of the wonderful people on here and will find alot of great info. welcome and nice to meet you,

have a good night all

richard

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** Originally posted by AnnieHernandez **

I have Regence and they initially refused to cover Enbrel unless I tried topicals 1st & failed and then did oral meds with light therapy and failed. The PUVA helped, but not as much as I had hoped. My derm fought for my Enbrel and we won. I've been on it for 7 months and am cleared most everywhere but my feet and they're much, much better.

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