United Healthcare coverage for Enbrel?

** Originally posted by lewislibrarian **

OK, I've just spent the last 15 minutes trapped in voice menu hell and speaking with 3 different people, none of whom could help me. Gaaaaah!

Situation: I am considering changing jobs, and the new job offers health coverage with United HealthCare.

Question: Does anyone here have United, and if so, do they cover Enbrel and with how many hoops to jump through?

You'd think it was a matter of national security with how hard it is to find this stuff out. The first lady transferred me to Customer Service (more like Customer Disservice) with their 8000 menus that all want a member number (I'm not one yet! Tell me some things, and I might be!). Then I got transferred to the pharmacy people (never mind that every time I've talked to my current insurers about it, I have to talk with the Medical Benefits people, and never mind that United's website says that biologics are under the medical benefits coverage). The pharmacy people recommended I contact United directly (isn't that what I did?) to find out about their deal with biologics. Ultimately, I have to join to find out whether or not I want to join. Gosh, thanks so much for the help. Sorry for the rant, but I am sooo irked right now.

So anyway, this group is tremendously helpful (unlike United), so I know I'll find out whatever information y'all can give. Thanks!

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8 replies. Join the discussion

** Originally posted by nsf103 **


I'm sorry you had a bad experience with United Healthcare...I've always had positive results when dealing with them.

Anyways, I was on Enbrel last year and United covered most of it, but I did have to pay $50 for a month supply as they classified it as a "non-preferred" drug. Also, my derm submitted paperwork to a particular pharmacy here in NYC that helped to get me more coverage. It didn;t seem like too many hoops - he just drafted something saying that I had tried many toher options and nothing worked, P was affecting my quality of life, etc.

If you currently have United, I suggest using their website to find out about covergae as I have always found it helpful - http://www.myuhc.com

Good luck with United & Enbrel!!!


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** Originally posted by Bubbbles2002 **

I have always had positive results with United Healthcare as well. Do you know if they will be going through a mail order pharmacy? Because my company goes through Caremark, and they are wonderful, and there customer service is outstanding, at least thats what I have noticed so far!! :)


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** Originally posted by trace **

Have you tried asking the human resources department of the company you are considering for a benefit packet and a copy of the drug formulary? perhaps this will help. Trace

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** Originally posted by katee **

Depending on the length of time your new company will take to let you have benefits, will probably decide if you need to carry COBRA as you are switching companys.
If there is any lag between one insurance coverage and another, even if it is with UH in both cases, you could find yourself uninsured for preexisting if there is not a seamless conversion by obtaining COBRA and being covered during the new processing time.
COBRA is expensive.
But it is not as expensive as being denied claims because there was a timing hole in which you did not have coverage.
You need to talk directly with HR in both companys and see if they can do any insurance assurance. However, because there can always be some
unforseen problem, I personally would bite the bullet and do the COBRA.
(because that is exactly what we did)
Also, do consider that while Enbrel might be on the non prefered list, that the 40.00 payment for a months supply is much easier to digest than the 1,600.00
price tag on the standard retail pharmacy.
Also, with United Health, there are a lot of different kinds of coverage and Pharmacy plans. UH is a very big and complex Insurance.
Your benefits will depend on many things. Mostly what your new employer might be offering and exactly who will be doing the administration of benefits.

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** Originally posted by lewislibrarian **

Thanks for the responses! I had already planned on doing COBRA--it is so less expensive than paying out of pocket for Enbrel! And I know that with any insurance company, different plans cover different things, but most insurance companies have a fairly unified policy concerning specialty drugs, to wit, how many/which therapies you have to have failed, how much paperwork it will take, whether it's covered with copay or by a percentage. After my husband's experience with United, I'm worried that they will totally stiff me on the Enbrel.


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** Originally posted by katee **

The Enbrel web site has a whole page
dedicated to Insurance FAQs

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** Originally posted by rjw123 **

All policies are different but I was on United Healthcare and wish I still was. I had to go through the methotrexate first, then waited about 6 weeks for approval, then they covered the Enbril. If you have already been through MTX, or are already on Enbril it will be even easier. I was paying $80.00 every three months and was getting it delivered by mail from Medco.

Unfortunately I now have BC/BS, and they will only pay about 50% of the total cost...oh to have United Healthcare back again!

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** Originally posted by tphillips **

My company just switched to United Health Care. I have been able to get Enbrel for $50 per month. I did not have to submitt papers or etc. I just went to my local pharm and purchased the Enbrel.

I have only received one month supply thus far (we just switched 1st of March). I will be going this weekend to get another month supply.


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