Posted by PatB
on February 17, 2000 at 10:43:20:
In Reply to: Rheumatoid and Psoriatic Arthritis posted by A. N. Francis on February 16, 2000 at 14:46:33:
: My wife is being advised by her Rheumatologist to consider starting Embrel treatments. She has had this disease for 20 years. The doctor has increased, as of today,the dosage of Methotrexate attempting to give her some relief from the pain and swelling of the joints. Embrel is very expensive. Are any of you who are currently taking the drug having any trouble getting your insurance providers to pay for this prescription? Answers to this and any other experiences you are having would be most helpful. Thank you so much for your help. A.N. Francis
Having only PA and not RA it took about three months to get Enbrel approved by the insurance. RA was FDA approved before PA was fda approved but now al you need to do is ask the insurance and with RA either they will or won't. My secondary insurance is Blue Cross/ Blue Shield under Federal Employees and they finaly approved Enbrel for me but you do have to show that you tried other DMARDs first and what results you got. Methotrexate irritated my liver so I had a reason to switch. Since your wife has had RA and PA for so long she has tried many meds and it should be easy for a response from the insurance. The people that get mad seem to be the ones that get diagnosed one day and demand the most expensive drugs on the market to treat them the next day. Sort of like wanting a Cadillac before trying to see if you could live and get around with a compact car just fine. The insurance wants people to get medicines but they also want to be able to stay in business. If the patient could get good results with methotrexate for under $100 a month why should they spend over $1000 a month for a more expensive drug?
The treatment thought today is to treat aggressively at the start to hinder the formation of deformities in the future. Quite a few patients want to stay away from strong drugs as long as they can and try healthful living ideas and limited anti-inflammatories. If they have MILD symptoms I can see theie reasoning but if they are in pain all the time I vote for aggressive treatment. I wish everybody responded the same to the meds so there would be a single drug that worked miracles but that just hasn't yet.
I've been on Enbrel about 4 months and was able to cut my pain meds in half. I've been more mobile. I sleep better at night. My psoriasis isn't touched by Enbrel so I have to use scalp solutions and ointments again.
Just ask the insurance,