Friday, January 30, 2009 Luis, Community Member, asks

Q: Will SSD cover the cost of Enbrel? Do I qualify?

My insurance is only paying $400 of the $1995 I'm paying for Enbrel. I cannot afford to continue on Enbrel even though it has done wonders for me. Does anyone know of any programs that may help with some of the cost? Does SSD cover medication or just doctor care? I'm 54. If I apply for SSD what does that normally cover.  I just need help with meds, if I can't get the meds I will not be able to work!  Please advise.

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Answers (5)
nan, Community Member
2/ 2/09 1:07pm

I am also on enbrel.  In the begining I was on a program that gave me my enbrel.  So connect the manufacture and apply for their program.  You must be a U.S. citizen, have no prescription insurance, and meet the low income standards.  When I got my medicare not pay for my enbrel that I could go back on their program.  I have community care as my Medicare D and I had to get approval before they would pay for it but I it approved and I pay 5.80 a month for my enbrel.  Study the internet and you will find different programs for meds. If your not able to do this, find an advocate to help you. If I can help my email address is thesandycrafters@gmail.com 

 

Hope this helps

Nan

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EnergizerBunny, Community Member
1/31/09 10:00pm

Have you contacted Enbrel?  They have program that may help you.  I don't qualify for it because I am on Medicare and they will not help anyone on Medicare.  Like you I can't afford the cost; therefore, I am not even trying Enbrel.  I failed Remicade and am in such agony that I just wish I could find a hole to crawl into and die.  But I have two beautiful grandchildren (ages 3 and 5) that need me and keep me going.  So I just keep plugging away each day.  My doctor hasn't decided what to try next as yet.  Right now I am taking only methatrexate and prednisone.   Good luck.  EnergizerBunny

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beachboy, Community Member
7/15/11 7:21pm

Recently, my doctor told me about Sulfasalazine and Plaquenil as a cocktail to take along with the Methotrate and Prednisone.  You may wish to speak with your doctor about these additional drugs because they may offer some relief. These additional drugs are relatively inexpensive and I think they would be covered by Medicare.

 

Also, I am not sure whether you are using the maximum dosage of Methotraxate.    I believe you can safely use up to 25 mg / week.  I currently also use 10 mg of the Prednisone / day with little side effect.  Ultimately, I am trying to eliminate the Prednisone but I am thankful that I can use it.  Before I used it... I could not walk.  And I was in massive pain for months before I could get a dianosis and a prescription for Prednisone.  I had a terrible relapse recently and my doctor prescribed 60 mg of some crystaline form of time released steriod.  It was injected and i got relief within 1 day.  Previously I could not walk and I was in pain for two weeks so I understand your situation.

 

I will say a prayer for you because I completely understand how you feel.  As I said, I could not walk and I was ready to leave the earthly plane as well.  But we all have a purpose. And we must endure and find a way to heal.  Good luck... and God Bless you.  

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daisy1, Community Member
2/20/09 5:44pm

There is a company called Patient Access Network.  They have helped me pay my co-pay and co-insurance.  They may be able to help you.  The number is 1-866-316-7263 or you can search the web for other places that can help.  Thanks

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Helen Enbrel, Community Member
3/ 3/10 1:50pm

I am a 57 years old female.  I have worked my entire life.  I was diagnosed in approximately 1998 with Rhematoid Arthritis.  I tried several different medications with little effect on my RA.  My Rhematoid Arthritis Doctor suggested that I try Enbrel along with Methotrexate and I can't beleive the difference.  I am able to continue work and perform normally.  I am estatic about the benefits from using Enbrel.  Recently, under United Healthcare I had to change from PPO coverage to HRA and have discovered that my co-pay which had been only $40.00 in the past was for January $739.00.  I have had to be furloughed days on my job and my income has suffered considerablly.  If I can't get help with my co-pay I will have no choice but to discontinue the Enbrel.  Please help me so that I can live a normal life and continue my job.  I am too youg to give up so easily.

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Dee, Community Member
4/ 8/10 7:57pm

Hello,

I am on Enbrel sureclick shots weekly and I ran into this same problem.  Last year I applied for The Encourage Foundation to get a year free to take the Enbrel and you have to apply on your own, because if approved they send the shots from the foundation to your home.  Now, that I fininally got medicare and had to get supplemental insurance, my insurance will only pay 70% and then I am left to pay 500.00 a month which I cannot afford, so I talked to the Encourage Foundation and they sent me a application for a company called "The Healthwell Foundation."  I had to get my derm to fill out one page of it but sending that off today.  I did fine on the Enbrel for the first 5 or 6 months and I really enjoyed being clear but just being on one shot a week didnt work for me coz I had major breakout and so am back on the two a week.  I dont like the side effects but what to do?  Anyways, I hope this will help.  Good luck to you and your skin

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By Luis, Community Member— Last Modified: 03/04/14, First Published: 01/30/09