The past few days have been so frustrating. My pain is getting worse by the hour, and I'm so worried I won't get the Enbrel as soon as I expected. We do have terrible insurance, and I think they're going to give me the run around, even though I've been a very inexpensive customer of theirs all these years--almost 20 years of using cheap cortisone creams for my psoriasis, and a little light therapy here and there--nothing that put it into remission, but only basically moisturized my scales. I buy OTC MG217 shampoo, so there's no insurance payment on that. Since I've been diagnosed with PsA, I've taken very few meds, mostly OTC pain meds--my doctor suggested a biologic way back when--when I didn't feel sick enough to want to be doctoring all the time. When he suggested sulfasalazine, I figured if it wouldn't help my psoriasis, why take it? Now, suddenly over the course of the past six months, my joints are hurting more and more and I can see disfigurement. For two days now, my right wrist is stiff and painful with a bump coming out the side!!!! What next? My fingers are ALWAYS sore, my feet are ALWAYS sore, my neck is ALWAYS sore--I'm getting P.T. on that starting next week. But, I just feel like the Enbrel can't be started soon enough and I do NOT want to waste time trying several different DMARDS. Do DMARDS even help psoriasis? Sounds like all they do is make people feel like crap and cause liver damage. Sorry for being such a crab but it's hard to function in life when you feel pain no matter what you do. I know there are worse things than this....it's just really hard because nobody knows what a person with P and PsA is going through. I told my husband today, I can't even imagine what life would be like without psoriasis--I've put cream on twice a day, every single day since I was about 22. 38 years. The unsightliness of it is so embarrassing for me. Today it was 85 degrees and I walk around in long pants and a long-sleeved shirt. People ask me if I'm nuts!!!! I just make excuses like, oh, my office is always cold, so I dressed warm for work today. Maybe I am nuts--from this DISEASE that's driving me nuts!!!! Sorry! I have to vent--I could vent to myself, I guess. I'm just having another feel-sorry-for-myself day, and I don't have anyone else to talk to about this. Just so frustrated because the doctor had to do an urgent appeal to my insurance because they denied the Enbrel, which I was under the impression it had already been approved. My daughter who works there (at the derm clinic) told me people get Enbrel JUST for having scalp psoriasis! I have so much more! Sorry, I'll shut up now! Thanks for all your support!
You have to try dmard before getting approved for Enbrel.. Then once u get approved.. Co pay is 0 for first 6 months.. Then after that it is $10 per month..
Call them. They will explain the process.. Wsh u luck
I am sorry you feel frustrated. It isn’t uncommon insurance companies to give the run around for biologics. Technically you don’t need to try traditional DMARDS for approval as long as your doctor fills out the appropriate paper work. You may get several denials in the process, but just keep trying. Methotrexate does ok for plaque psoriasis, but not as well for other forms. If possible, get a recommendation to a pain specialist - I am glad I did.
Grandma, you are a pretty tough cookie, but you don't always have to be strong. It is OK to vent and OK to need to feel like you are being taken care of. Maybe if you went out in temperature appropriate clothing the people in your life would understand that you are really dealing with a disease. I understand just going on and functioning as if nothing is wrong for many years. It can be hard to admit that something is kicking your ass. Right now it is, and you have to operate differently.
You may have a real wait until there a better medical resolution to your condition. If the people close to you really get what is happening and treat you accordingly it will make the wait less difficult. My husband woke up early one morning this week and saw my funny, very slow morning sideways hobble down the stairs. He was shocked because I do so much every day. He just didn't really understand how I was doing. For the first time in 20 years he has started doing some of the projects around the house. I can't tell you how much better I feel emotionally even though physically nothing has changed for me.
I guess what I am saying is that while you wait out getting treated properly there are probably people in your life who will support you better, and differently if you let them really see how you are doing.
As long as you have insurance the covers the medication (not medicare etc.), you don’t need to start with traditional DMARDs. The doctor needs to file the appropriate paperwork. Initially, it may get denied, but as long your are diligent and appeal the decision is possible to get it approved.
I started with Enbrel - did not try anything but topological steroids. It’s significantly easier to get it approved through a derm than rheum.
Thanks everyone. I'm trying to be optimistic. Maybe I'll get some good news today. Can't help but think this disease messes with the mind because I never used to be a complainer about anything. The disease can really get you down!
mataribot said:
As long as you have insurance the covers the medication (not medicare etc.), you don't need to start with traditional DMARDs. The doctor needs to file the appropriate paperwork. Initially, it may get denied, but as long your are diligent and appeal the decision is possible to get it approved.
I started with Enbrel - did not try anything but topological steroids. It's significantly easier to get it approved through a derm than rheum.
Relax. Dmards do help or I certainly wouldn’t waste my time. Methotrexate does help P; I have a friend who was on it for years with no difficulty. No one wants to have the side effects, but if you go in with an open mind and all the right information, you can successfully take them without too much suffering! However, it doesn’t look like you have to take it prior to a bio. It’s getting to where the bios are much easier to get covered.
IF your insurance denies the preauthorization? Appeal it. Have your doc write a medical necessity note. In most cases, those are approved.
Also, you do not have to try a DMARD before a bio. This is the case in the UK, but NOT in the US. Also, and this is weird, but it seems that it is easier to get approved for A bio for P through the dermatologist. Just a thought for if you have issues with getting it approved for PsA through the rheum.
Hey, GrumpyCat! It got approved today (through an urgent appeal from my dermatologist). I don't understand the logic of it being easier to get a biologic approved through a dermatologist, but now I'm sure glad I went that route. I mean, really, I might have continued putting up with this disease if I only had P, Idk. It is the pain and disfigurement and thought of possible future disability of PsA that gave me the push to do something! I'm just so glad it's gonna happen! Now I'm wondering how many days before the mail order pharmacy calls me to set up a delivery time?
GrumpyCat said:
Also, you do not have to try a DMARD before a bio. This is the case in the UK, but NOT in the US. Also, and this is weird, but it seems that it is easier to get approved for A bio for P through the dermatologist. Just a thought for if you have issues with getting it approved for PsA through the rheum.
They should call within 24 business hrs of getting the script from your doc. If not, follow up with the doc and with the pharmacy.
Grandma J said:
Hey, GrumpyCat! It got approved today (through an urgent appeal from my dermatologist). I don’t understand the logic of it being easier to get a biologic approved through a dermatologist, but now I’m sure glad I went that route. I mean, really, I might have continued putting up with this disease if I only had P, Idk. It is the pain and disfigurement and thought of possible future disability of PsA that gave me the push to do something! I’m just so glad it’s gonna happen! Now I’m wondering how many days before the mail order pharmacy calls me to set up a delivery time?
GrumpyCat said:
Also, you do not have to try a DMARD before a bio. This is the case in the UK, but NOT in the US. Also, and this is weird, but it seems that it is easier to get approved for A bio for P through the dermatologist. Just a thought for if you have issues with getting it approved for PsA through the rheum.
Luckily I went online this evening after not getting a phone call from the insurance company today. Sure enough there was an online message from the company that will be shipping my Enbrel asking me to call them and set up an account. That takes 24-48 hrs, so I'm hoping it's 24! This disease makes me anxious and impatient. After that she said it could take 3-5 days before I'd receive my Enbrel. You guys know all this stuff already, so Idk why I'm telling you....just can't control my excitement!
You're doing great! Some specialty pharmacies seem to be run by complete morons, others are really good. (I've had one of each!) You seem to have a good one.
It's weird that insurance companies approve biologics more quickly when the derms ask- I would have guessed just the opposite. You were asking earlier about DMARDs. Methotrexate cleared my plaque psoriasis quite well. It is a bit of an energy suck, but I tend to be over-sensitive to drugs, and I've done really well with meth. No liver problems, no odd side effects.
You have signed up for the co-pay assistance for Enbrel, haven't you? If not, do that before you arrange shipping or it could come with a nasty little surprise.
Hi Louise! I'm over-sensitive to meds too-always take the smallest dose of anything and it works. For instance my BP med is the dose my doc told me she'd prescribe to an 80-yr old 90 lb. lady! I insisted to start out on that small dose-and it's been working for a long time! And, yes, I did sign up for Enbrel support, so I just need to give them the account numbers when we arrange for shipping. Can't wait!!!!
Louise said:
You're doing great! Some specialty pharmacies seem to be run by complete morons, others are really good. (I've had one of each!) You seem to have a good one.
It's weird that insurance companies approve biologics more quickly when the derms ask- I would have guessed just the opposite. You were asking earlier about DMARDs. Methotrexate cleared my plaque psoriasis quite well. It is a bit of an energy suck, but I tend to be over-sensitive to drugs, and I've done really well with meth. No liver problems, no odd side effects.
You have signed up for the co-pay assistance for Enbrel, haven't you? If not, do that before you arrange shipping or it could come with a nasty little surprise.