Enbrel price/packaging dilemma

** Originally posted by Jables **

Went to my pharmacy today and I was quoted a cost for Enbrel 50mg/ml SureClick injector @ $360 per injection (cash price)..
My insurance tells me my copay for injection type medications like Enbrel is 10%... My math skills tell me that should come out to $36 per injection..
The pharmacy is telling me my copay is $68.50 which would be just under 20%... Is something wrong? Have any of you had this same type of experience where your coverage calls for a certain percentage, then when it comes to getting the medications it ends up being higher? I actually spoke to a person on the phone today from my insurance carrier and they told me that my copay is 10% for injections... I'm a little confused here and would like to know what i should do next.

Also when you get Enbrel does it come in a package of (4) 50mg/ml injections or do they come individually?

Any help would be appreciated.. Thanks

Sam

Report post

13 replies. Join the discussion

** Originally posted by PJ66 **

Sam,
I don't know about the sure click but the reg. enbrel comes 4 in a box.
Polly

Report post

** Originally posted by seedoubleyou **

Hi Sam: Enbrel SureClick IS packaged 4 per box.

My insurance (BCBS Arizona) considers Enbrel, et al a "specialty medication" and is covered under the major medical part of my policy. Has to be filled via a "specialty pharmacy," and is shipped UPS. My co-pay is $60/month.

Wishing you well w/E!! :)

Report post

** Originally posted by Jables **

Hi Sam: Enbrel SureClick IS packaged 4 per box.

My insurance (BCBS Arizona) considers Enbrel, et al a "specialty medication" and is covered under the major medical part of my policy. Has to be filled via a "specialty pharmacy," and is shipped UPS. My co-pay is $60/month.

Wishing you well w/E!! :)

Thank you for your help..

How many syringes is for $60/month?

Report post

** Originally posted by seedoubleyou **

Depends on one's dosage. I'm on 1-50MG injection/weekly so when using the SureClick, I received 1 box/month.

If you've been RXd more than 50MG/week (and some people are), you should receive 2 boxes.


(BTW, I've since switched to the vial-adapter method -- the old mix-it-yourself formula -- which are only 25MG/injection. This way, I do TWO injections at a time and receive 2 boxes of 4/month.)

Report post

** Originally posted by MikeK **

Hi Sam,

The price for Enbrel can apparently vary from store to store. Unless your insurance requires you to use a specific pharmacy, it may be worth your time and effort to "shop around". Enbrel's customer services program, Enliven Services (http://www.enbrel.com or http://www.enlivenservices.com/), was able to help Sue (Beachbound) significantly lower her out of pocket expenses by arranging for her to get Enbrel from a mail order pharmacy. She shared her experience (along with some specific examples of the prices charged by different pharmacies in her area) in these threads:

http://www.psoriasis.org/forum/showthread.php?t=11307;

http://www.psoriasis.org/forum/showthread.php?t=11753.

I hope this helps. I hope and pray that Enbrel turns out to be your wonder drug.

Keep us posted!

Mike

Report post

** Originally posted by SCCatman **

When people with P start Enbrel, they typicaly do 50mg twice a week for 3 months, then drop to the starndard 50mg once a week.
Those with just PA start at the "normal" 50mg once a week dose.

Every insurance plan is different. Most that I have heard of are fixed copay or 20% or 30% copay.
Yous may be 10% for generic and 20% for name brand (there is no generic enbrel).

I do also the 20mg mix it youself shot because the 50mg premix and autp injects have a preservative that stings when you do the injections.
I had rather do twice as many shot that have zero pain, than half as many that sting a bit. Personal choice.


Best wishes.
Dennis

Report post

** Originally posted by winelover215 **

I just got my first month filled at Rite aid pharmacy in Pa. It was for 8 doses (2 boxes) in the SureClick Auto Injector. My copay with Aetna was $15.00.

For future months I must go through Aetna Specialty Pharmacy and the copay will still be $15.00.

Good luck with your quest. I have high hopes for Enbrel. :)

Report post

** Originally posted by RichJ **

hi winelover215,
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

Report post

** Originally posted by Jables **

Thanks for all your replies..

Here is whats going on with the issues i'm having..

I have Blue Cross/Blue Shield which is my insurance... They have a 3rd party administrator that handles all of my insurance claims.. The company is called Delta Health.. Basically if i have any questions about claims or benefits, i have to call them.. They send me statements on the behalf of Blue Cross detailing what was paid..

Now here's the other interesting part of my situation.. When it comes to anything to do with pharmacy and/or drug issues, i have to deal with ANOTHER company called Express Scripts.. They are a pharmacy benefit manager that pays for all of my medications..

So in short i'm dealing with two different entities right now and was getting two different answers.. After many phone calls along with lots of confusion, and headaches, i think i've finallly got this all figured out...
My copay for generics is 10%, and 20% for name brands.. Enbrel is obviously name brand and my copay payment of 20% for a month supply comes out to $540.. Originally i was told that injection type medications is a 10% copay.. Turns out that is true but ONLY for injections received at a doctors office or a hospital.. That is where i was getting confused..

I simply cannot afford $540 a month for Enbrel right now.. My next step is to try to apply for some copay assistance through Healthwell Foundation, and perhaps "shopping around" more for a better price..

Report post

** Originally posted by SCCatman **

Another option is for remicade, it must be given at a doctor's office.
I think several people have chosen that option because it counts as a doctor's vist instead of a pharm.
It is an infusion (IV thingy), not a shot, which may make a difference on how it is covered as well.
Best wishes
Dennis

Report post

** Originally posted by Jables **

Another option is for remicade, it must be given at a doctor's office.
I think several people have chosen that option because it counts as a doctor's vist instead of a pharm.
It is an infusion (IV thingy), not a shot, which may make a difference on how it is covered as well.
Best wishes
Dennis

Yeah i considered that but for the time being i'm going to try my best to get Enbrel.. I simply do not have the time to sit in a doctors office for 2 hours.. My work schedule is so hectic right now, its hard enough being able to make time for all these phone calls to insurance..

Report post

** Originally posted by MikeK **

Thanks for all your replies..

You're very welcome, Sam.

After many phone calls along with lots of confusion, and headaches, i think i've finallly got this all figured out...
My copay for generics is 10%, and 20% for name brands.. Enbrel is obviously name brand and my copay payment of 20% for a month supply comes out to $540.. Originally i was told that injection type medications is a 10% copay.. Turns out that is true but ONLY for injections received at a doctors office or a hospital.. That is where i was getting confused..

I simply cannot afford $540 a month for Enbrel right now.. My next step is to try to apply for some copay assistance through Healthwell Foundation, and perhaps "shopping around" more for a better price..

Sigh. I'm so sorry. I'm going to give you a link to a thread that was started by Leslie (Momtotwogirls). She took the time to post links and information about some assistance programs that she came across. I added links and information about programs (such as the Healthwell Foundation) that people have either told me about or that have been discussed on the board. There's even a link to a post from the NPF's staff that gives links and information to the assistance programs that they know about. We don't know very much about most of these programs, it can't hurt to check them out. Here's a link to Leslie's thread: http://www.psoriasis.org/forum/showthread.php?t=12379&highlight=Leslie.

I hope this helps.

Mike

Report post

** Originally posted by Jables **

Does these copay assistance foundations help with copays at regular pharmacies or only mail order?

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