Guest guest Posted July 28, 2003 Report Share Posted July 28, 2003 Janet, If you have problems with your insurance carrier, I might be able to help you. I do medical review for an insurance company and Enbrel is NOT experimental in any way. Most insurance companies need to see documentation of you failing other drug therapies before they will authorize it. Please let me know if you need any additional assistance. You can email me privately if you wish - I'm happy to help any way I can. Good luck! Hugsssss and God bless, Sandy From: "janetlou59" Reply-Rheumatoid Arthritis Rheumatoid Arthritis Subject: Back from Seattle Date: Mon, 28 Jul 2003 00:01:45 -0000 Hello All, Well I just returned from Seattle and was very pleased with the Rheumatologist that I saw there. He wants me to start on Enbrel. Only problem is that my insurance company is balking that it is an experimental drug. I had to have the Dr. write a letter of medical necessity and they said it could be up to 3 weeks before they let me know. My pharmacist says that is will be approx $1500 per month if I have to self pay. I need to do something. Because I have tried all of the other drugs in the past and have already suffered more joint damage and bone loss than I even realized, he wants me to go directly to the Enbrel. Unfortunately I contracted Parvovirus(yes there is a human version of this) this Spring and that is what is causing my recent awful flare. Those of you with children or involved with children, be aware of Fifth's Disease. It's a childhood disease that when kids get it is fairly benign. However if adults, particularly women get it it can be quite disabling. Fatigue, severe joint pain, low grade fever and flushing of cheeks. I guess if you already have RA it's rather like adding insult to injury. At least that explains why I have felt the worst I have in 15 years. Have any of you had problems getting insurance companies to cover the drugs? Has anyone ever gone to Canada to get the drugs? I heard on NPR that this is becoming a popular approach to out of reach pharmacutical costs. Wish me luck. Thanks for listenning. Janet Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2003 Report Share Posted July 28, 2003 P.S.. My initial onset of RA was after catching 5th Disease (Erythema Infectiosum) from my son when I was 35. From: "janetlou59" Reply-Rheumatoid Arthritis Rheumatoid Arthritis Subject: Back from Seattle Date: Mon, 28 Jul 2003 00:01:45 -0000 Hello All, Well I just returned from Seattle and was very pleased with the Rheumatologist that I saw there. He wants me to start on Enbrel. Only problem is that my insurance company is balking that it is an experimental drug. I had to have the Dr. write a letter of medical necessity and they said it could be up to 3 weeks before they let me know. My pharmacist says that is will be approx $1500 per month if I have to self pay. I need to do something. Because I have tried all of the other drugs in the past and have already suffered more joint damage and bone loss than I even realized, he wants me to go directly to the Enbrel. Unfortunately I contracted Parvovirus(yes there is a human version of this) this Spring and that is what is causing my recent awful flare. Those of you with children or involved with children, be aware of Fifth's Disease. It's a childhood disease that when kids get it is fairly benign. However if adults, particularly women get it it can be quite disabling. Fatigue, severe joint pain, low grade fever and flushing of cheeks. I guess if you already have RA it's rather like adding insult to injury. At least that explains why I have felt the worst I have in 15 years. Have any of you had problems getting insurance companies to cover the drugs? Has anyone ever gone to Canada to get the drugs? I heard on NPR that this is becoming a popular approach to out of reach pharmacutical costs. Wish me luck. Thanks for listenning. Janet Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2003 Report Share Posted July 28, 2003 Thanks Sandy. I will let you know what they say. I've been told it could take 2-3 weeks for them to decide. I'm facinated by your story. I was told that the arthralgia from Fifth's Disease goes away with the virus. Since I already had the RA diagonosis I didn't think about the fact that it could stay this bad. I really hope that I can get started on the Enbrel soon. Thanks for the reply. Janet > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 29, 2003 Report Share Posted July 29, 2003 Hi Janet, I was on Enbrel and my insurance company paid, but I have a friend whose insurance will not pay for any new injectable medication because they do not have a proven track record (or so they say) ... it is expensive, but when it works, it works well ... unfortunately it didn't for me so now I am on prednisone to reduce all the swelling so we can figure out what to try next ... I wish you the best and I do hope the insurance company comes through ... be well ... hugs ... nne > Hello All, > Well I just returned from Seattle and was very pleased with the > Rheumatologist that I saw there. He wants me to start on Enbrel. Only > problem is that my insurance company is balking that it is an > experimental drug. I had to have the Dr. write a letter of medical > necessity and they said it could be up to 3 weeks before they let me > know. My pharmacist says that is will be approx $1500 per month if I > have to self pay. I need to do something. Because I have tried all of > the other drugs in the past and have already suffered more joint > damage and bone loss than I even realized, he wants me to go directly > to the Enbrel. Unfortunately I contracted Parvovirus(yes there is a > human version of this) this Spring and that is what is causing my > recent awful flare. Those of you with children or involved with > children, be aware of Fifth's Disease. It's a childhood disease that > when kids get it is fairly benign. However if adults, particularly > women get it it can be quite disabling. Fatigue, severe joint pain, > low grade fever and flushing of cheeks. I guess if you already have > RA it's rather like adding insult to injury. At least that explains > why I have felt the worst I have in 15 years. > Have any of you had problems getting insurance companies to cover the > drugs? Has anyone ever gone to Canada to get the drugs? I heard on > NPR that this is becoming a popular approach to out of reach > pharmacutical costs. Wish me luck. Thanks for listenning. Janet Quote Link to comment Share on other sites More sharing options...
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