For many patients managing chronic inflammatory conditions such as rheumatoid arthritis or psoriasis, Enbrel (etanercept) is a vital treatment. However, the high price of this biologic medication can create a significant financial burden. The key is to actively seek out and combine different savings methods based on your unique insurance and financial situation. From manufacturer-sponsored aid to independent nonprofits, here are the primary avenues to make your Enbrel prescription more affordable.
Manufacturer programs: Financial support directly from Amgen
As the manufacturer of Enbrel, Amgen offers two primary programs designed to help patients with costs.
Amgen SupportPlus Co-Pay Program
This program is for commercially insured patients. It can help eligible patients pay as little as $0 out-of-pocket for their Enbrel, covering costs like deductibles, co-insurance, and co-payments up to an annual maximum. It is not available for those with government insurance like Medicare or Medicaid. Enrollment is available online or by phone.
Amgen Safety Net Foundation
This patient assistance program provides Enbrel at no cost to eligible uninsured or underinsured patients residing in the U.S.. Eligibility is based on household income relative to federal poverty guidelines and lack of sufficient insurance coverage. Approved patients can receive medication for up to 12 months, with the possibility of re-enrollment. Applications can be submitted online or via paper form, potentially with help from a healthcare provider.
Using prescription discount cards
Prescription discount cards can provide immediate savings for those without qualifying insurance.
How pharmacy coupons work
Services like SingleCare and GoodRx offer free coupons. You can search for Enbrel on their websites or apps, compare prices at local pharmacies, and present the coupon with your prescription to potentially save significantly off the retail price. Savings vary by pharmacy, dosage, and location.
Government and nonprofit assistance programs
Additional support can be found through government plans and independent charitable foundations.
Medicare and Medicaid
Coverage for Enbrel under government plans varies. Medicare Part D may cover it, potentially requiring prior authorization. Amgen can assist Medicare beneficiaries in understanding costs. The "Extra Help" program aids low-income seniors with Part D expenses. State Medicaid plans may also cover Enbrel, with costs varying by state and plan. Amgen notes that many Medicaid beneficiaries have low out-of-pocket costs.
Charitable foundations
Independent organizations offer financial grants.
- PAN Foundation: Offers grants for specific conditions treated by Enbrel.
- Patient Advocate Foundation (PAF): The Co-Pay Relief Program helps insured patients cover co-pays, co-insurance, and deductibles.
- HealthWell Foundation: Provides copay assistance for insured patients who meet certain criteria.
Comparison of financial assistance options
Savings Method | Best For | Typical Cost | Eligibility Requirements | Pros | Cons |
---|---|---|---|---|---|
Amgen Co-Pay Program | Commercially Insured Patients | As little as $0 out-of-pocket | Commercial insurance, Enbrel covered by plan | Significant savings, direct manufacturer support | Ineligible for government insurance plans, annual maximum benefit applies |
Amgen Safety Net Foundation | Uninsured/Underinsured Patients | Free medication | Financial need, lack of sufficient insurance | Free medication, covers uninsured | Income limits, requires application process |
Prescription Discount Cards | Uninsured or High-Deductible Patients | Variable, but significantly reduced retail price | Anyone can use them | Immediate savings, widely accepted at pharmacies | Not as substantial as full assistance programs |
Government Programs (Medicare/Medicaid) | Medicare or Medicaid Beneficiaries | Variable (copay, deductible) | Based on income, state of residence, and plan rules | Comprehensive coverage for eligible patients | Potential prior authorization requirements, specific plan rules |
Nonprofit Foundations | Insured Patients Facing High Costs | Variable (grant-based) | Diagnosis-specific, income limits | Targeted financial aid, helps with co-pays/deductibles | May have income caps, grants may run out |
Other strategies for reducing costs
Other approaches can also help manage Enbrel costs.
Discussing alternatives with your doctor
Alternative medications, including biosimilars, may be more affordable. Discussing other TNF inhibitors or DMARDs with your doctor can help determine if they are suitable options.
Using HSA or FSA funds
Using a Health Savings Account (HSA) or Flexible Spending Account (FSA) allows you to pay for Enbrel with pre-tax income, reducing your overall cost.
Asking for free samples
Your doctor may have free Enbrel samples available for new patients, providing a temporary supply while you explore long-term assistance.
Conclusion
Affording Enbrel is possible through various financial assistance options. Explore manufacturer programs, discount cards, government benefits, and nonprofit aid. Work with your healthcare provider and pharmacy to find the best approach for your situation. Visit the Amgen SupportPlus website for more information.