Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group enbrel

i found out i was denied coverage for enbrel today. So now do i just suck it up and live with this pain? I has gotten sooooo much worse in the last few week. does anyone recomend any thing else?

I'm sorry you got denied. Can't you appeal? Or contact enbrel via their website (www.enbrel.com) and ask for some financial resources? You shouldnt have to live in this much pain!

am really sorry to hear about that, i can understand you feelings. But enbrel is really nice medication for all AS survivors . i wish you can get approval

When I was first put on enbrel my doc said he would have to get ahold of my insurance to see if they covered enbrel. He then told me not to worry because if they did not there were other ways to get it thru the enbrel company. I am not for sure how it works but you might want to ask you doc. And as cherkipps said check the website for enbrel. they might have it on there what to do.

Good luck. I hope you find the answers you are looking for.

have a blessed day
hugs
Raquel

not sure why you were denied. what to do next probably depends on the reasons for being denied. though, i'd work with the doctor that dx'ed you to get approved. and if that doctor won't work with you, find one that will. i was denied a medication initially, and my doctor had me write a letter of appeal that she signed, then i was approved no problem....

sue

I would call your insurance company & find out why you were denied. Some insurances require that you "fail" on the DMARDs first (Mtx, Sulfasalazine, etc.) Have you taken any of those?

What is your actual diagnosis? Many companies will only approve the biologics if it is one of the diseases the FDA has really approved the drug for, they won't pay for a biologic to be used "off-label".

Intially my rheumy had dx'd me with reactive arthritis & Enbrel was denied. Further testing resulting in a dx of AS & failing to see improvement with DMARDs alone got me approved for biologics.

So try to find out what your criteria your insurance company requires for the biologics, then see if your doctor can comply.

I would definetely find out why you were denied. Perhaps you hadn't tried any medications prior to Enbrel. That could be one reason. Has your doctor tried to get you approved for Remicade? Maybe they would approved that? When I changed jobs back in 04, I had to stop taking Enbrel because my new insurance wouldn't pay for a penny of it no matter what I did. I also was just barely making to much money for assistance so I was unable to take it for almost 4 years until I got my new job in November then in February I was approved for it through my new insurance. I hate to say it but the only thing I had available for almost 4 years was Motrin. I literally took thousand of them just to help alleviate some of the pain, but it was better than nothing.
I sure hope you find out why you were denied and let us know what you can do.

Best wishes,

Glenn

Thanks for all the responses. I am definatley going to speak with my Dr. This isnt over yet i guess!

thanks again,
Sasha

you doctor needs to write compelling prose to your insurance co's fax machine.
you can appeal their decision...all it takes a bit of time.
enbrel can also be helpful in explaining the facts of life to your ins co...
they are/can be very persuasive and will bombard your insusrace co with lit too...
test result, etc, etc.

good luck

If this is your first go-around with Enbrel, Enliven/Enbrel has a program that provides your first 5 (I believe) shots for free. Check out the website and see if you might qualify for this. www.enbrel.com or www.enliven.com

This might be the way to go whilst your doctor is getting you approval. Just a thought. Good luck.