So I recently started enbrel after much waiting. I signed up for the copay assist and was given a card with $8,000 on it to cover my cost for the first year. Well I got the unfortunate and disgusting news that my copay is $1,900 a month!! I’ve reached my deductible, I’ve called multiple people to make sure I was reading it correct and yes enbrel is $3,300 a month and I have a 40% coinsurance for specialty drugs. I will max out my assistance in less than 5 months and will then have to pay almost $2,000 a month which is IMPOSSIBLE. I no longer work because of how bad my hands are and I have never had a job that offered insurance. I have paid out of pocket for private insurance for years. I’m not sure what to do at this point but I know I will have to stop enbrel if I have to pay $1,900 a month. I finally get on a path to my new normal and once again it blows up in my face. Anyone else experience this??
I’m not in the US, so I haven’t experienced what you have, but I was faced with an unaffordable scenario last year. The stress was terrible, but I managed to find a solution. I think your next move needs to be to call Enbrel assistance, and explain the situation to them. Don’t mince words. Tell them that you are going to have to stop, something that they don’t want to see happen. Please let us know what they say!
Best of luck, we’re thinking of you!
What did they say when you called them and told them that you were going to have to stop? Our experience here is that they are very helpful to peoople with private insurance. That kind of co-pay is not an affordable one for any normal working person.
Oh my... I was worried about that too but fortunately for me our insurance is great and our copay was next to nothing. I saved the Psoriasis Advance magazine from Spring 2015 just in case as there was an article about assistance with copays. One of the links listed was for NPF Financial Assistance Resource Center www.psoriasis.org/financial-help. If you would like the magazine, I be glad to send it to you or I can copy the article and Email it to you. Just let me know.
Absolutely lay it on the line when you speak to Enbrel support. My understanding is that they are able to help the overwhelming majority of people in need.
I know your pain but I look at it this way. If this medicine me back a quality of life where I can spend with my family and friends and keeps me out of the doctor offices, I feel it is well worth it. We had to cut back and I mean cut back so I can keep on it. We get help from assistance and it is not much but anything helps. Please do not give up call, write and ask questions but do not give up.
Your best bet may be to shop for better insurance, that covers essential services. The premium for a AHC silver plan that would cover your meds would be far less than your copay. If you are not eligible for a cap on the portion of your income spent on healthcare (about 4%), because you didn't go through the complete process that's something you should do... I you still aren't eligible, you may have to make some life style adjustments........ The money is there if you aren;'t eligible for the AHC subsidies.
Beyond that you have to do what you have to do. My 401K is gone, we are selling the house to pay off the second mortgage we took out to cover expenses when we didn't have insurance. We don't have any regrets. Well one - moving after 30 years in the same place is a hassle.......
We are fortunate to have some great friends and family that helped us prevent a real catastrophe with this last go round this spring.