{"id":629918,"date":"2024-09-30T14:52:10","date_gmt":"2024-09-30T18:52:10","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=629918"},"modified":"2026-01-13T13:15:39","modified_gmt":"2026-01-13T18:15:39","slug":"does-medicaid-cover-enbrel","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-medicaid-cover-enbrel\/","title":{"rendered":"Does Medicaid cover Enbrel?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.singlecare.com\/prescription\/enbrel\">Enbrel<\/a> (etanercept)<\/span><span style=\"font-weight: 400;\"> is a brand-name prescription medication for treating autoimmune diseases such as rheumatoid arthritis, psoriasis, and ankylosing spondylitis. It belongs to a class of medications called tumor necrosis factor (TNF) inhibitors. A TNF inhibitor is a protein that white blood cells produce in the body that plays a role in inflammatory processes. <\/span><span style=\"font-weight: 400;\">Enbrel<\/span><span style=\"font-weight: 400;\"> is given as a self-injection, and it works by blocking proteins in your body that cause pain and swelling.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medicaid is a program funded by states and the federal government that provides health insurance to low-income individuals and families. While the coverage and eligibility criteria for Medicaid can vary from state to state, the program ensures that those most in need have access to essential healthcare services, including prescription medications like Enbrel.<\/span><\/p>\n<h2 id=\"how-much-does-enbrel-cost\"><span style=\"font-weight: 400;\">How much does Enbrel cost?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Without insurance or Medicaid, Enbrel can be expensive. On average, a 30-day supply of <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/enbrel-without-insurance\/\"><span style=\"font-weight: 400;\">Enbrel costs $9,446 without insurance<\/span><\/a><span style=\"font-weight: 400;\"> or discounts, which can be a significant barrier for many patients.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Several factors can influence the price:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Dosage:<\/b><span style=\"font-weight: 400;\"> The diseases being treated, the dosage, and the frequency of injections can impact the overall monthly cost.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Pharmacy:<\/b><span style=\"font-weight: 400;\"> The price of Enbrel can vary between pharmacies. Pharmacists can help you compare prices at different locations.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Location:<\/b><span style=\"font-weight: 400;\"> Costs can also differ based on geographic location.\u00a0<\/span><\/li>\n<\/ul>\n<h2 id=\"does-medicaid-cover-enbrel\"><span style=\"font-weight: 400;\">Does Medicaid cover Enbrel?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The answer is not a simple yes or no. In most cases, Enbrel is covered by Medicaid, but certain factors must be considered when determining coverage. Different Medicaid plans have unique drug lists, or <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/what-is-a-formulary\/\"><span style=\"font-weight: 400;\">formularies<\/span><\/a><span style=\"font-weight: 400;\">, which are lists of medicines that they will pay for. Enbrel may be included in this formulary, but it&#8217;s essential to confirm this with your state&#8217;s Medicaid program or your unique Medicaid plan.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some states may cover Enbrel, while others may not. In states where Medicaid includes Enbrel in its preferred drug list, there may still be specific criteria you must satisfy before your healthcare provider can prescribe it.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">For example, some state Medicaid plans may cover Enbrel<\/span><span style=\"font-weight: 400;\"> for conditions like rheumatoid arthritis if it meets specific criteria and prior authorizations are obtained. The approval process may involve submitting detailed information about your medical condition and previous treatments.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you have both Medicare and Medicaid, you are considered dually eligible, meaning<\/span> <a href=\"https:\/\/www.medicare.gov\/basics\/costs\/help\/medicaid\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">you may be able to use Medicaid to pay for certain things that Medicare won&#8217;t<\/span><\/a><span style=\"font-weight: 400;\">, though this is not necessarily a guarantee.<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-enbrel\/\"><b>Does Medicare cover Enbrel?<\/b><\/a><\/p>\n<h2 id=\"factors-influencing-medicaid-coverage-of-enbrel\"><span style=\"font-weight: 400;\">Factors influencing Medicaid coverage of Enbrel<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If Medicaid covers Enbrel in your state, there may be specific requirements you must meet. These may include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>A confirmed diagnosis: <\/b><span style=\"font-weight: 400;\">Your healthcare provider must diagnose you with an autoimmune condition that Enbrel is used to treat<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Proof of medical necessity:<\/b><span style=\"font-weight: 400;\"> Your healthcare provider must demonstrate that Enbrel is necessary for your specific condition and that other treatments are ineffective. This process, known as <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/step-therapy\/\"><span style=\"font-weight: 400;\">step therapy<\/span><\/a><span style=\"font-weight: 400;\">, involves trying less expensive medications before trying Enbrel.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Prior authorization:<\/b><span style=\"font-weight: 400;\"> If your state\u2019s Medicaid agency requires <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/prior-authorization\/\"><span style=\"font-weight: 400;\">prior authorization<\/span><\/a><span style=\"font-weight: 400;\"> for Enbrel, your healthcare provider must get approval from Medicaid before the prescription may be filled at the point of sale. The process typically involves submitting detailed information about your condition and why Enbrel is necessary.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Your income level:<\/b><span style=\"font-weight: 400;\"> Medicaid coverage can also depend on your income level. Some states have specific income thresholds determining eligibility for certain benefits, including prescription medications like Enbrel.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">To determine whether Medicaid covers Enbrel in your state:<\/span><\/p>\n<ul>\n<li><b>Check your state&#8217;s Medicaid website. <\/b><span style=\"font-weight: 400;\">Each state has a <\/span><a href=\"https:\/\/www.medicaid.gov\/state-overviews\/index.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Medicaid website<\/span><\/a><span style=\"font-weight: 400;\"> that lists information about covered medications and services. This site can provide specific details about Enbrel coverage in your state.<\/span><\/li>\n<li><b>Call your local Medicaid office.<\/b><span style=\"font-weight: 400;\"> Contacting your local Medicaid office can provide direct information about Enbrel coverage. They can explain the process for obtaining coverage and any additional requirements.<\/span><\/li>\n<li><b>If your Medicaid plan is managed instead of fee-for-service, check your managed Medicaid plan\u2019s formulary. <\/b><span style=\"font-weight: 400;\">This will let you know not only whether it covers Enbrel but also how much of a copay you\u2019ll be responsible for at the pharmacy.<\/span><\/li>\n<\/ul>\n<h2 id=\"how-to-get-enbrel-with-medicaid\"><span style=\"font-weight: 400;\">How to get Enbrel with Medicaid<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If you want to obtain Enbrel with Medicaid coverage, follow these steps:<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Discuss your condition and treatment options with your healthcare provider. <\/b><span style=\"font-weight: 400;\">If Enbrel is deemed appropriate, they will write a prescription.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Allow time for prior authorization. <\/b><span style=\"font-weight: 400;\">Don\u2019t assume you\u2019ll be able to start taking Enbrel right away.<\/span> <span style=\"font-weight: 400;\">Filling your Enbrel prescription can take more time than other medications if Medicaid requires prior authorization. Your healthcare provider may first have to submit the necessary forms and information to Medicaid for approval, proving that Enbrel is necessary for your specific condition.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Fill the prescription:<\/b><span style=\"font-weight: 400;\"> Once Medicaid approves the prior authorization, you can take the prescription to your pharmacy.\u00a0<\/span><\/li>\n<\/ol>\n<h2 id=\"cost-of-enbrel-with-medicaid\"><span style=\"font-weight: 400;\">Cost of Enbrel with Medicaid<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Medicaid may cover the complete cost of Enbrel, or it may require you to pay a copay. Ultimately, it depends on your Medicaid plan. You may have out-of-pocket expenses such as:<\/span><\/p>\n<ul>\n<li><b>Copayments:<\/b><span style=\"font-weight: 400;\"> Some plans require a copayment for each prescription. The <\/span><span style=\"font-weight: 400;\">copay amount<\/span><span style=\"font-weight: 400;\"> may depend on whether your state considers Enbrel a preferred or nonpreferred drug.\u00a0<\/span><\/li>\n<li><b>Coinsurance:<\/b><span style=\"font-weight: 400;\"> Sometimes, you pay a percentage of the medication cost, known as coinsurance. For example, you might pay 10% of the medication&#8217;s price.<\/span><\/li>\n<li><b>Monthly premiums:<\/b><span style=\"font-weight: 400;\"> Depending on your income and Medicaid plan, you might have to pay a monthly premium for Medicaid coverage. The amount can vary based on your state and specific Medicaid program.<\/span><\/li>\n<li><b>Deductible: <\/b><span style=\"font-weight: 400;\">Some plans have a deductible, which is an amount you have to pay before coverage begins.\u00a0<\/span><\/li>\n<\/ul>\n<p>To understand what you&#8217;ll pay, check your state Medicaid preferred drug list.<br \/>\n<b><\/b><\/p>\n<h2 id=\"ways-to-get-discounts-on-enbrel-without-medicaid\"><span style=\"font-weight: 400;\">Ways to get discounts on Enbrel without Medicaid<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If you don&#8217;t have Medicaid or if your state doesn&#8217;t cover Enbrel, you can still find ways to save on the medication:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>SingleCare prescription discount card:<\/b><span style=\"font-weight: 400;\"> The <\/span><a href=\"https:\/\/www.singlecare.com\/prescription-discount-card\"><span style=\"font-weight: 400;\">SingleCare discount card<\/span><\/a><span style=\"font-weight: 400;\"> offers digital coupons that can lower the cost of Enbrel at many pharmacies. For example, with a <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/enbrel\"><span style=\"font-weight: 400;\">SingleCare coupon for Enbrel<\/span><\/a><span style=\"font-weight: 400;\">, you could pay $7,449 instead of $9,446 for four syringes, a one-month supply.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Manufacturer coupons:<\/b><span style=\"font-weight: 400;\"> Check the manufacturer\u2019s website for Enbrel to see if it offers any coupons or discount programs. These programs may provide significant savings on the medication.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Enbrel patient assistance:<\/b><span style=\"font-weight: 400;\"> The <\/span><a href=\"https:\/\/www.amgensafetynetfoundation.com\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Amgen Safety Net Foundation<\/span><\/a><span style=\"font-weight: 400;\"> offers a <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/enbrel-patient-assistance\/\"><span style=\"font-weight: 400;\">patient assistance program<\/span><\/a><span style=\"font-weight: 400;\"> that provides free medication, including Enbrel, to eligible patients who can prove that they are ineligible for Medicaid and meet certain income requirements.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Generic alternatives<\/b><span style=\"font-weight: 400;\">: While Enbrel itself doesn&#8217;t have a <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/enbrel-generic\/\"><span style=\"font-weight: 400;\">generic version<\/span><\/a><span style=\"font-weight: 400;\"> yet, your healthcare provider might know of other similar <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/enbrel-alternatives\/\"><span style=\"font-weight: 400;\">Enbrel alternatives<\/span><\/a><span style=\"font-weight: 400;\"> that are more affordable.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">To find out whether Medicaid will cover your Enbrel prescription, check with your local Medicaid office for the most up-to-date information. By being informed and proactive, individuals can navigate the complexities of Medicaid coverage for Enbrel and access the treatment they need for their autoimmune condition.<\/span><\/p>\n<p><small><i><span style=\"font-weight: 400;\">The SingleCare prices in this article are the most accurate at the time of publishing in ZIP code 23666 as of Jan. 13, 2026. Prices vary by pharmacy. Visit our <\/span><\/i><a href=\"https:\/\/www.singlecare.com\/prescription\/enbrel\"><i><span style=\"font-weight: 400;\">Enbrel coupon page<\/span><\/i><\/a><i><span style=\"font-weight: 400;\"> for updated Enbrel prices near you.<\/span><\/i><small><\/small><\/small><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Enbrel (etanercept) is a brand-name prescription medication for treating autoimmune diseases such as rheumatoid arthritis, psoriasis, and ankylosing spondylitis. It belongs to a class of medications called tumor necrosis factor (TNF) inhibitors. A TNF inhibitor is a protein that white blood cells produce in the body that plays a role in inflammatory processes. Enbrel is [&hellip;]<\/p>\n","protected":false},"author":149,"featured_media":629920,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[4343,16],"coauthors":[21032],"class_list":["post-629918","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-brand-name-drugs","tag-medicaid","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Does Medicaid cover Enbrel?<\/title>\n<meta name=\"description\" content=\"Medicaid covers Enbrel, but coverage details vary by state, and some may require beneficiaries to meet specific eligibility requirements before covering the drug.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, 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