← Return to My Life Depends on Using Enbrel

Discussion
phxbarb avatar

My Life Depends on Using Enbrel

Autoimmune Diseases | Last Active: 2 hours ago | Replies (7)

Comment receiving replies
Profile picture for laura1970 @laura1970

This is from AI. The short version is to make sure you pick a part D plan or advantage plan that lists enbrel on its formulary. This is easy to do on Medicare.com website. Also remember that with part D, medication costs are capped at $2000 per year.

Yes, Enbrel is often covered by Medicare, but only through certain types of plans and under specific conditions.[singlecare +2]
How Medicare Can Cover Enbrel
• Original Medicare (Parts A and B) by itself does not cover self-injected drugs like Enbrel; you generally need prescription drug coverage through either a standalone Part D plan or a Medicare Advantage plan that includes drug coverage.[oakstreethealth +1]
• Many Part D and Medicare Advantage plans do list Enbrel on their formularies, but coverage, prior authorization requirements, and out-of-pocket costs vary by plan and location.[medicalnewstoday +2]
Typical Requirements and Costs
• Plans usually require that Enbrel be prescribed for an FDA‑approved indication such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, or plaque psoriasis, and may require step therapy or prior authorization.[healthline +1]
• Enbrel is treated as a “specialty” drug, so coinsurance or copays can be high, but starting in 2025, annual Part D out‑of‑pocket spending on covered drugs is capped (around $2,000), after which the plan pays the rest for that year.[medicalnewstoday]
Help With Costs
• Some people qualify for Medicare’s Extra Help program or state pharmaceutical assistance programs, which can greatly reduce copays for Part D drugs like Enbrel.[singlecare +1]
• The manufacturer (Amgen) also offers financial support resources, though some copay programs may not apply to people with government insurance, so eligibility details matter.[enbrelpro +2]
What You Should Do Next
• Check your plan’s formulary (or use the Medicare Plan Finder) to see if Enbrel is listed, what tier it is, and what your expected copay or coinsurance would be.
• Ask your prescriber’s office and your specialty pharmacy to help with prior authorization and to screen you for Extra Help or manufacturer assistance based on your income and resources

Jump to this post


Replies to "This is from AI. The short version is to make sure you pick a part D..."

@laura1970 So, did you sign up for Medicare part D?