Enbrel coverage
The biologic drug Enbrel is a man-made protein, similar to a protein found naturally in the body. Enbrel works by capturing or "soaking up" TNF and interrupting the process that can lead to the symptoms of RA. The effects of Enbrel last up to four to five days. Enbrel is a fused protein made from human components. With Enbrel there may be up to a 3% incidence of antibodies formed against the drug. Because tumor necrosis factor (TNF) plays a key role in the response of the immune system to infections, it is possible that the action of blocking TNF may worsen or increase the occurrence of infections. Patients with serious infections should not receive anti-TNF drugs. If a serious infection develops during the course of treatment with anti-TNF drugs, the drug should be discontinued. Enbrel is not recommended for patients with preexisting disease of the central nervous system or for those with multiple sclerosis, myelitis, or optic neuritis. The new biologic drugs are expensive. Enbrel is self-injected and classified as a "prescription drug". Coverage will vary according to insurance plan. Another anti-TNF drug called Remicade is given as an infusion in either a doctor's office or hospital setting. It is classified as a "treatment". Medicare and Medicare supplement plans will cover Remicade, but will not cover Enbrel since there still is no prescription drug plan for Medicare recipients, unless they have secondary insurance. When Enbrel was first approved, the cost was quoted as $220/week, or between $11,000-$12,000/year. Most private insurance plans will cover Enbrel. The company that makes Enbrel (Amgen/Wyeth) also has different patient assistance programs.
Abbott, the company that makes another self-injectable anti-TNF drug, Humira, also has a patient assistance program. The average wholesale price of Remicade is $611.33 per vial. The average RA patient will require two to three vials per infusion, and receive about 6 treatments per year following the initial dose period at 0, 2, and 6 weeks. There is also additional cost involved with Remicade to pay for the personnel and treatment facility required to administer the infusion. For rheumatoid arthritis patients whose symptoms come largely from rampant TNF-alpha, Enbrel or Remicade can work miraculously. By controlling the biological activity of TNF-alpha, these drugs are capable of controlling the activity of the disease. The drugs generally work rapidly and patients who respond well usually feel better within a couple of weeks. All three TNF-inhibitors now have sampling programs, so ask your rheumatologist about them.
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