United Healthcare to Change Coverage

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United Healthcare to Change Policy on Enbrel Coverage

CreakyJoints is your personal watchdog. And we have learned that as of January 1, 2015, United Healthcare has made changes to its pharmacy programs for biologics used to treat rheumatic, dermatologic, and inflammatory bowel disease. Several biologics have had their tier status changed. This impacts the amount of hoops you are required to jump through to get your medicine. As if living with these conditions wasn’t hard enough, we’re afraid that there are more hurdles for us patients to overcome.

Enbrel etanercept

We have noted one change that impacts many members of the CreakyJoints family. United Healthcare will require a “step therapy” barrier for new patients who are prescribed Enbrel. This means that before new patients can receive Enbrel, they must first try and fail on two specific biologics before they are given the Enbrel that their physician originally prescribed them. If you use a co-pay assistance coupon for Enbrel, United Healthcare’s Specialty Pharmacy network – OptumRx – will no longer accept it.
Step therapy is also known as “fail first policy”. It is a way for insurance companies to lower its costs. We believe that cost savings come at the detriment to patients and their relationship with their physician. Insurance companies should not be allowed to practice medicine without a license. Don’t worry, you are not alone! CreakyJoints is prepared to fight for you.


Help us help you!

Do you have United Healthcare insurance? Have you been impacted by its decision? Share your story with us. We will make sure the right people hear it and we will protect your identity. Our goal is to bring the faces, names, and voices impacted to the forefront. The executives at United Healthcare need to know how their decision impacts the emotional, financial, and medical well-being of their customers – and our members. Please email [email protected] to share your story.


Get the facts straight:

If you are a current Enbrel user…
United Healthcare is not completely shutting down your coverage. Enbrel is still covered for you, however, you may see a spike in your co-pay when you go to pick up your prescription at the pharmacy.


First, the bad news…
Under this new policy, you’ll be required to pay the out-of-pocket cost for your Enbrel prescription.


Now, the good news…
There is still co-pay assistance available to you from the manufacturer of Enbrel (Amgen). Amgen will reimburse you for the out-of-pocket cost. All you have to do is apply for co-pay reimbursement with them. Call 1-888-4ENBREL (1-888-436-2735) Monday – Friday from 8:00 AM to 8:00 PM ET to speak to an Enbrel support reimbursement counselor.


How it works:
Getting Enbrel financial support through co-pay card benefits takes three steps:
* Shell out the cash for the out-of-pocket cost of your Enbrel prescription.
* Send in your receipt via e-mail, snail mail, or fax, to the manufacturer.
* The manufacturer reimburses you with a check for the money you spent and they deliver it to you within 3 business days.


If you are not a current Enbrel user...
If it’s after January 1, 2015 and your doctor decides Enbrel is the best treatment for your rheumatic, dermatologic, or inflammatory bowel disease…

And, you have United Healthcare, you will be required to try and fail two of these four medications: Cimzia, Humira, Simponi and Stelara.

It’s very important that you and your doctor are on the same page. Make sure you have a conversation with your doctor about this. Only you and your physician should decide the most appropriate therapy for your disease!


CreakyJoints has your back. If you have questions or just need more help in understanding how to navigate this process, email us [email protected] or call us at 845-348-0400 (Mon – Fri, 8:00 AM to 8:00 PM ET).



Steve Marmaras
Manager, State and National Advocacy
AKA Your Watchdog