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Is Enbrel covered by insurance | How much does Enbrel cost without insurance? | How to get Enbrel without insurance
Enbrel (etanercept) is a brand-name prescription drug that reduces the symptoms of certain inflammatory autoimmune diseases: rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, and polyarticular juvenile idiopathic arthritis. Etanercept is a monoclonal antibody that partly blocks the immune system at the start of an inflammatory response.
Enbrel is taken as a 50 mg injection right beneath the skin once per week, but psoriasis treatment will require twice-weekly 50 mg injections for the first three months of treatment. Children taking Enbrel for juvenile idiopathic arthritis will take doses based on their body weight. Enbrel is a very high-priced medication with an average retail price of $8,000 per month. Paying for Enbrel without insurance coverage is daunting, but it can be done using a variety of cost-saving strategies.
RELATED: Enbrel side effects
Is Enbrel covered by insurance?
Many commercial health insurance plans, Medicare prescription drug plans, and Medicaid plans cover Enbrel. Be prepared, however, for the insurance company to ask for prior authorization before approving it.
How much does Enbrel cost without insurance?
People without insurance coverage for Enbrel will pay an average of $8,000 for a 30-day supply of four 50 mg Enbrel Mini autoinjectors, Enbrel AutoTouch autoinjectors, or prefilled syringes. The annual cost of Enbrel treatment approaches $100,000 at full price, making it unaffordable for most people.
The actual out-of-pocket costs for people with insurance will depend on the plan’s deductible, coinsurance percentage, copay cost, and, for Medicare prescription drug coverage, the current phase.
Other antibody disease-modifying antirheumatic drugs (DMARDs) such as Orencia (abatacept), Rituxan (rituximab), and Kineret (anakinra) are less expensive than Enbrel, but they each still cost several thousand dollars per month. For some patients, the only affordable solution may be traditional DMARDs, prescription medications that include corticosteroids, methotrexate, hydroxychloroquine, Azulfidine (sulfasalazine), Arava (leflunomide), and Azasan (azathioprine). Chances are, however, that many of these traditional DMARDs have already been tried and found lacking, so it may be worthwhile to ask about starting a medication that has not been tried yet.
While some over-the-counter medications or dietary supplements may help relieve the symptoms of rheumatic conditions or psoriasis, none can effectively reduce the signs and symptoms of these conditions.
Compare Enbrel prices to related drugs |
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|---|---|---|---|
| Drug name | Price without insurance for brand-name drug | SingleCare price | Savings options |
| Enbrel (etanercept) | $8,000 for 4, 1 mL of 50 mg/mL solution prefilled syringes | $5,645 for 4, 1 mL of 50 mg/mL solution prefilled syringes for brand-name Enbrel | See updated prices |
| Remicade (infliximab) | $7,085 for 4, 100 mg solution reconstituted vials | $1,897 for 4, 100 mg solution reconstituted vials for brand-name Remicade | See updated prices |
| Cimzia (certolizumab pegol) | No coupon at this time, please check back periodically | More details | |
| Humira (adalimumab) | $7,343 for 2 prefilled syringe kits | $6,056 for 2 prefilled syringe kits for brand-name Humira | See updated prices |
| Simponi Aria (golimumab) | $9,000 for 4, 4 mL of 50 mg/4 mL solution vials | $7,721 for 4, 4 mL of 50 mg/4 mL solution vials for brand-name Simponi Aria | See updated prices |
Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. The listed price without insurance references the price of brand-name drugs. The listed SingleCare price references the price of generic drugs if available. Click the link under “Savings options” to see updated drug prices.
How to get Enbrel without insurance
With an annual price tag approaching $100,000, Enbrel is not affordable at the full cash price. Unfortunately, even people with insurance may find that Enbrel is difficult to afford. However, it is possible to get Enbrel treatment even without insurance. It will require trying many different strategies and maybe even more than one at a time, but it can be done.
1. Get a prescription discount with a SingleCare savings card
People with an Enbrel prescription can save over $2,000 off the average retail price of Enbrel just by getting a free coupon from SingleCare. A SingleCare discount card can be printed or downloaded in seconds for immediate use at participating pharmacies.
2. Get a free sample from the prescriber
The prescriber may be able to give first-time patients one or more Enbrel doses. It isn’t a permanent solution, but a single dose is worth over $2,000.
3. Ask the prescribing healthcare provider about Amgen’s patient assistance program
Patients without insurance should begin the process of enrolling in Amgen’s patient assistance program. Eligible patients may receive Enbrel for free or get other financial support. The program has eligibility requirements and shouldn’t be considered a permanent solution, but it is a start. The prescriber should have additional information and be able to help with eligibility requirements and enrollment.
4. Health insurance
For people without health insurance, one way to pay for an Enbrel prescription over the long term is to get a health insurance policy. Use an agent to make sure that the policy will cover Enbrel at a reasonable out-of-pocket cost.
5. Enroll in Medicaid
If commercial health insurance is not affordable, then Medicaid may be an option. If you qualify for Amgen’s patient assistance program, you may qualify for Medicaid. According to Amgen, 93% of people with Medicaid coverage for Enbrel pay less than $10 for their monthly prescription.
6. Ask the prescriber about traditional DMARDs
As a last resort, people who can’t afford Enbrel or other biologic DMARDs may need to return to traditional DMARDs like methotrexate or corticosteroids. Usually these drugs have been tried and found to be ineffective before a healthcare professional prescribes Enbrel or a similar drug, so this decision may be difficult to make.
