11/28/2023 0 Comments Enbrel copay card activationProgram benefits are limited to the co-pay costs for ORENCIA that the patient receives as an outpatient.The Program may apply to out-of-pocket expenses that occurred within 180 days prior to the date of enrollment. The enrollment period is 1 calendar year. The submitted form must include the name of the insurer, plan information, show that ORENCIA IV was the medication given, and be submitted within 180 days of the date of the EOB. For ORENCIA IV infusion, in order to receive Program benefits, the patient or provider must submit an Explanation of Benefits (EOB) form or a Remittance Advice (RA).Upon expiration, eligible patients may re-enroll using the same card. The Card expires at the end of the calendar year following activation. The Card must be activated before use and includes 13 uses per calendar year.For ORENCIA subcutaneous self-injection, the Co-pay Assistance Card must be presented at the pharmacy, along with a valid prescription for ORENCIA, at the time of purchase.Patients enrolled in co-pay maximizer programs may receive program benefits that vary over time to ensure the program funds are used for the benefit of the patient. A co-pay maximizer program is one in which the amount of the patient’s out-of-pocket costs is adjusted to reflect the availability of support offered by a co-pay support program. Some prescription drug plans have established programs referred to as ‘co-pay maximizer’ programs.Eligible patients with an activated co-pay card and a valid prescription may pay as little as $5 per 30-day supply monthly, annual, and/or per-claim maximum program benefits may apply and vary from patient to patient, depending on the terms of a patient’s prescription drug plan and to ensure that the funds are used for the benefit of the patient, based on factors determined solely by Bristol-Myers Squibb.Patients or their guardian must be 18 years of age or older.Patients must be treated with ORENCIA for an FDA-approved indication.Cash-paying patients are not eligible for co-pay assistance.Patients who move from commercial to federal health insurance will no longer be eligible. Patients who have insurance coverage through a state or federal healthcare program, including Medicare, Medicaid, Medigap, CHAMPUS, Tricare, Veterans Affairs (VA), or Department of Defense (DoD), are not eligible.Co-pay assistance is not available if patient out-of-pocket expenses are $5 or less. Patients must have commercial insurance that pays for ORENCIA but does not cover the full cost. Admittedly difficult for a lot of people, but still better than actually spending it. Now, that does mean you would need to shell out that money initially, and then have them pay you back a month later. I'm not sure what you mean by "my insurance (Express Scripts) does not put the co-pay assistance towards my deductible or out of pocket" - for one, ExpressScripts is a pharmacy benefits manager, not an insurance company, and for another, I use ExpressScripts to fill my equally-expensive psoriatic arthritis medication (Taltz) and they certainly apply the co-pay assistance to my insurance's deductible & out-of-pocket maximum.ĭo you have commercial insurance, and aren't using Medicare or something? If so, even if your insurance company won't apply the payment to your deductible directly, you should be able to get the drug manufacturer's co-pay assistance program (Amgen in the case of Enbrel, I believe) to reimburse you directly for your deductible. Do I really need to shell that all out if I want Enbrel or do I have any other options? My deductible is around 1500 and out of pocket is something like 3800. I asked what am I supposed to do then? They told me I am ineligible for any Enbrel programs and I would need to pay my entire deductible/out of pocket myself. I was transferred to an Amgen Edge specialist who then verified my household income and told me that my income was too high for this program. But when I mentioned to the representative that my insurance (Express Scripts) does not put the co-pay assistance towards my deductible or out of pocket, she said I was ineligible for their co-pay assistance program but I might be eligible for their Amgen Edge program for people in this situation with their insurance. I then went to enroll in their co-pay card assistance program. I called Enbrel support today to ask about a rebate program. I recently was switched over to Enbrel due to Humira elevating my liver enzymes. So I used to be on Humira and I used their rebate program which worked very well. I am ineligible for any Enbrel financial assistance and would need to pay my entire deductible and out of pocket myself.
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