Arthritis Drug Question

[gdr_11]

My wife has rheumatoid arthritis that has not responded well to methotrexate, prednisone and a couple of other drugs they have tried. Doc prescribed Enbrel but told us it as expensive and submitted an app to AMGEN for their subsidy program. Turns out even though we are well below the income level for assistance, they denied her because she has Medicare and the Medicare Advantage plan we have will cover the drug but with a $950 a week copay. AMGEN claims they only subsidise with private insurance or no insurance (interesting since the Obamacare act makes it illegal for anyone to not have insurance)

Does anyone here have any experience with a third party foundation or program that can help with the cost of Enbrel for low income seniors on medicare?

 

[baboon]

My pain doctor & my orthopedicdoctor both told my the Advantage plan is worse then not having one at all. My Doctor suggested an advantage policy thru Physicians Mutual IIRC. And I will be dumping my current advantage program ASAP during open enrollment.

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[gdr_11]

Thanks for the info; there are a lot of changes coming next month. I hear that Aetna and Humana are both getting out of the Texas market as far as the Advantage plans. Biden’s executive order that put a low ceiling on max out of pocket costs per year in 2025 will cost them millions do they will go where they can make more money.

I change almost every year because each plan changes and they bank on seniors staying with the same company; a trick they learned from the auto/home policy issuers