First of all, you should repost these questions on the rheumatoid arthritis message board. Go up to the top of this page, click on forums, then click on rheumatoid arthritis.

There are probably RAers there on Medicare and perhaps on enbrel, that may be of help.

Many folks on Medicare have a secondary insurance, a Medigap policy, and it may include a drug benefit. But what drugs are covered under that drug benefit will vary from plan to plan. Enbrel is an expensive drug, so some drug benefits plan do not cover it or cover only a portion of the cost.

Medicare also has a Medicare Part D plan, which is a "stand alone" drug benefit. I don't know a lot about it though. This might be an option for your dad.

There is a problem though with the Medicare Part D plan called the "donut hole." Once the plan covers a certain amount of prescription costs, you fall into the "donut hole" and are responsible for the total cost of a drug until you reach a certain amount and then "climb out of the donut hole," then Medicare Part D would cover most of prescription drugs costs.

It can get confusing and complicated, so post over on the RA message board, I and others, can try and help you over there.

The maker of enbrel also has an assistance plan, so you might try contacting them.

Yes, you should be concerned about his discontinued use of enbrel, uncontrolled, untreated RA is not good.

And, yes, there are many people like your father -- even with insurance -- public (medicare) or private insurance -- they have no affordable access to the drugs they may desperately need. That is why health care reform is so important.

See you over on the RA message forum.

Joy

Once at the RA Connect forum, look for the Welcome and General Information. You may find that post helpful. At the bottom or half way through it, there is info. on drug companies and their programs. Be sure to check into these for your Dad. Untreated RA is far more dangerous than just going without the medicine.
Hope to see you over at the RA forum.

Sylv

I know a great deal about Medicare Part B & Part D as well as supplemental state / federal programs like Medicaid (called MA, MediCAL, & other things in various states), SLMB, QMB, etc.

I have gotten insurance to pay for things everyone said they'd never pay for.

Please be concerned about your father just going off a medication like this - especially when it's given for such a serious condition.

Medicare Part D WILL cover Embrel for as little as $3.10 for a 3 month supply - DEPENDING upon your father's specific insurance & income info.

Since becoming disabled, I have no assets, my income is extremely low, so I get the supplemental aide - I don't currently have to worry about the "donut hole", "gap coverage", or how I'll pay my 20% that Medicare Part B doesn't cover on many services.

At least not for now. Unfortunately, soon I'll be faced w/ more difficult healthcare decisions than I'm even facing at this point.

If you care to leave a way to contact you, I'd be glad to assist in any way possible.

...rising!

This is still me from above on 5 Nov 2009