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Rheumy ordering Enbrel
#242393 10/19/12 12:13 AM
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Well, it finally happened...I couldn't ignore the horrific enthesitis anymore. When you can't sleep at night, and tend to face plant into the wall when you try to get up in the morning thanks to Achilles that are so tight you can't put your foot down flat, it's time to get over it. He was great; answered all my questions the best he could and encouraged me to email him with other questions as they pop up. Now starts the "approval game" with the insurance company.

Those of you on Enbrel, how long did it take to get your approval? Doc was great and encouraged me to immediately go their website and sign up for the info kits, watch the videos, and get on the co-pay assistance program (which I did, and it was REALLY easy to do!)

Thanks all! Here's to hoping for good things to come!


Kim: finishing the PhD SOMETIME in 2013! Dx'd with Undifferentiated Spondyloropathy (officially!) in October 2010 and gastroperesis in August 2011, now adding Sjorgren's and VERTIGO to the mix. Mom to 1 daughter with AS (on FULL disability), and 2 sons with UDiff (1 a graphic designer-freelance and 1 an elite level soccer player). Taking Enbrel (Oct. 2012) and Sulfasalezine (spring? 2011)
Re: Rheumy ordering Enbrel
Soccerdocmom #242394 10/19/12 12:38 AM
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I was in the same boat as you. I can relate to being so tight in the morning - hobbling on the balls of my feet. I could no longer tolerate the constant stiffness and pain. I called my Rheumy on a Monday morning at 9:00am to leave a message that I wanted to start Enbrel. By noon CVS called to say my prescription was ready. I was shocked that it was that easy. It took me another week to get the TB test planted and read and to receive instruction from the nurse in how to use the injector pen. I'm on my fourth week and have noticed mild improvement but still waiting for the life changing results that I've read about. A piece of advice - do take the pen out of the fridge for 30 minutes before injecting (it comes to room temperature quickly). Also ice your leg for a couple of minutes. Be prepared for some stinging as the medication goes in but ice does help. Good luck.


Dx: Spondyloarthropathy/Connective Tissue Disorder (2/12), AS (9/12) HLA B27 negative, sacroilitis on x-ray - Current Meds: Methotrexate (20 mg), Leucovorin (30 mg), Protonix, Relafen, Vicodin and Tramadol PRN, Enbrel (9/12) Humira (7/15)
Re: Rheumy ordering Enbrel
Soccerdocmom #242400 10/19/12 03:01 AM
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Kim,
I have been on Enbrel, I had 2 injections, then I had to stop so I could have spinal surgery so it's been 2 months since my surgery so I am back on Enbrel now my Dr gave me 3 weeks of samples. I had not heard anything from my Dr office about my approval so I called them today and spoke with the office mgr that gets the approvals from insurance, she said she didn't know anything about it so she called my insurance and within 20 minutes she called me back and said she got me approved for 1 year so they will be sending me Enbrel each month. Guess it depends on your insurance, I have BCBS and for long term Perscriptions I have to use Medco. To help with your out of pocket costs your Dr should give you a card to help with co-pay costs. Should cost you $5.00 month with the card, you do have to be approved, but it's worth looking into. I wish you the best!
Steve


Dx'd April 2012 Psoriatic Arthritis/Osteoarthritis/Degenerative Disc Disease, my Rhumy said I have had this 10-15 years untreated. Have had Iritis in both eyes since 2007 it comes and goes. HLA-B27 negative. Meds currently taking are oxycodone for pain as needed, Remicade (starting when insurance approves) I also am a diabetic and now have high blood pressure. Failed Enbrel, Humira, Diclofenac, Methotrexate and Predisone. Wonderful wife Sarah, and father to 3 pugs!!
Re: Rheumy ordering Enbrel
Soccerdocmom #242427 10/19/12 12:55 PM
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I have BCBS and I didn't need an pre auth, I was lucky enough to not even have to "fail" other meds before I went on it. But pre- authorizations can take up to 90 days.
The Enbrel support program is awesome. $0 co-pay for the first 6 months, then $10 after that. And you can renew the program annually as long as you still have private health insurance. I've even used the 24 hour nurses hot line that comes with it. And the sharps container program is really convenient.

I have had great a great response to the Enbrel and I hope you do as well. If you haven't heard back after two weeks, don't be afraid to call your insurance company to find out what the status is.
Good luck!


The mighty oak was once a little nut that stood it's ground

I'm a 34 year old happily married mother of two crazy boys. I have AS. I take HRT's daily,Celebrex 2x's daily, tramadol every 6 hours, flexoril at night, failed Enbrel, currently on Methotrexate and Remicade infusions.
Re: Rheumy ordering Enbrel
Soccerdocmom #242429 10/19/12 01:06 PM
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Hi Kim, all the insurance plans are different - mine works well and quickly so I had no trouble getting approved for anti-TNFs. Usually the pharm. insurance has to approve the self-injectables, but Remicade goes through medical insurance since it must be administered in a facility.

For me it took longer to get the TB testing done than to get started on the med. Once I was clear re: TB my doc gave me samples so I could start right away. I hope it goes smoothly for you too, and that the Enbrel helps well - and quickly!


Jen, 42, happy partner of James and Moma to Evan, 14, & Lucy, 12.5 (Crohn's dx @ age 3; on Remicade since April 2010.) I take piroxicam, Flexeril, & Nucynta ER nightly. 3 anti-TNFs didn't pan out for me.

"Science is the father of knowledge, but opinion breeds ignorance." -- Hippocrates
Re: Rheumy ordering Enbrel
Soccerdocmom #242511 10/20/12 05:36 AM
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Thanks all for the great advice! The nurse called me today to let me know she's already filled in the paperwork for insurance; she's just waiting on the radiology report from the TB test. I had a positive skin test 15 years ago and was put on the meds for 6 months at the time as a precaution (the x-rays have always been negative).

Thanks too for the reminder to take it out of the fridge for a few before injecting. I had forgotten that others have said to do that to help reduce the stinging/burning sensation. Mercifully, I'm not bothered by having to self-inject; I used to take B-12 injections, and the nurse said it's the same process and tiny needle.

Thanks again all!
PS: Steve, just saw in your signature you have pugs! We just have one, but I see more in our future....impossible to stay in a bad mood for long looking at those little clowns!


Kim: finishing the PhD SOMETIME in 2013! Dx'd with Undifferentiated Spondyloropathy (officially!) in October 2010 and gastroperesis in August 2011, now adding Sjorgren's and VERTIGO to the mix. Mom to 1 daughter with AS (on FULL disability), and 2 sons with UDiff (1 a graphic designer-freelance and 1 an elite level soccer player). Taking Enbrel (Oct. 2012) and Sulfasalezine (spring? 2011)
Re: Rheumy ordering Enbrel
Soccerdocmom #242524 10/20/12 04:02 PM
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I have Anthem BCBS but my prescriptions are managed by ExpressScripts. It took me about 3 weeks to get approved. They denied my initial claim immediately and my doctor had to do an appeal. I was really upset but it seems like its actully pretty standard. (My rheumatologist's office acted like it was normal and I read online about others having the same thing happen.) which is all to say don't get discouraged if you get the runaround at first. If that does happen I would suggest to keep calling to get updates, since I would never have known what was going on otherwise.


[+] 33, HLA-B27, advanced sacroilitis, recurrent iritis.
[+] Diagnosed with AS February 2012. Symptoms started in early 20s.
[+] Currently: Humira, Voltaren gel, bupropion, venlafaxine. Failed Enbrel & oral NSAIDs

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