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Enbrel And Humira Prescriptions


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6 replies to this topic

#1 RayH

 
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Posted 17 April 2008 - 05:52 AM

I am currently on Active duty and going through a MED Board. I take Humira shots for my AS. Does the VA cover these? They are taken every two weeks and cost about $700.00 ea. I was wanting to know because when I get out and if the Board doesn't rate me high enough (>3 0%)to keep tricare I would like to get them through the VA.

#2 jessejames

 
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Posted 17 April 2008 - 11:40 PM

I am currently on Active duty and going through a MED Board. I take Humira shots for my AS. Does the VA cover these? They are taken every two weeks and cost about $700.00 ea. I was wanting to know because when I get out and if the Board doesn't rate me high enough (>3 0%)to keep tricare I would like to get them through the VA.

I'm not sure if the VA will cover Embril, but I have was diagnosed with AS for over 38 years ago. I have a good if not the best private Rheumatologist and he suggested Embril right after it was approved for AS (Ankylosong Spondylitis-Rheumatoid arthritis mostly involving spine and larger joints.) I was curious as to whether you started soon after the diagnosis, and how it works for you. My Blue Cross did approve the shots or me, but at that time Embril had on their website a chat on discussions of how well it worked....there were many with SERIOUS side effects and many saying it woked great, but stopped working after a short while. I researched the drug and even called the Manufacturer who had an on-duty Registered Nurse. I have had skin cancers and problems with chronic sinus infections and quite a few kidney-urinary tract infections. The Nurse would NOT tell me not to try Embril, but after expalining all my chronice infection problems(whcih the drug manufacturer reccomends NOT taking it if you have chronic infections of any type) well I asked the Nurse if she were me, would she take it and she said NO. Also the fact that I have NO confidence in the FDA approving ANY drug, made my decision to not take it. My Doctor pushed it, I'm SURE he got a good kick-back on prescribing it, but it scared me.

#3 RayH

 
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Posted 18 April 2008 - 06:53 AM

I too was hesitant on taking the Enbrel. I decided to start taking it after I got severe IRITIS twice. My Optamologist recommended it after my Rheumy did. It worked very well for about a year then I was having a lot of painful flareups in my hips, shoulders, etc,........ My Rheumy(Navy Doc) offered to switch me to Humira. I did so a few months ago. I am having less flareups. We shall see how long (hopefully a long time) this works. I am currently going through a MED Board and would like to leave knowing that I can get the medicine cheaper than paying for the whole cost out of my pocket.

I hope you are doing fine w/o taking it. I would probably feel the same way you do if I had the health issues you did.
Are you rated by the VA with your AS?

#4 jessejames

 
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Posted 18 April 2008 - 02:45 PM

I started having problems while in the service with AS and within a week after I got out, I was hospitalyzed for over a week...not being able to walk because of the pain. Back then, 1969-70, no one could diagnose what my problem was....I went to approx 15 Doctors. I know AS is supposededly a genetic thing and I have a positive HLBA 27, but not one out of 8 siblings had this. I just worked around it with lots of OTC pain medications for several years until I was sent to a specialist who diagnosed it in 1980. I knew I still carried schrapnel from a booby trap in Nam and some say AS is caused from bacteria etc and I sure had enough of that in Nam, so I filed and went all the way to the BVA with my claim for AS and was denied...this was before we had the COVA... so I had no where to go. I waited awhile and filed again under joint pain etc and was awarded 20% which was later moved up to 40% to include degenerative disc disease. I didn't know at the time, but the 4 or 5 denials that my AS was service-related was a blessing in disguise. I worked for about 18 years as a Postal City Carrier until I just plainly could not do it anymore, and anyone who has worked for the Postal Service knows there is NO help at all for a disabled worker, I applied for over 40 jobs with a low score of 105 on the Civil Service exam, because I had 10 points added for Purple Heart, anyway EVERY single one was turned down and as they say, they just plain wore me out. I had been having more problems with Supervisors etc and the VA had awarded me 50% PTSD. I finally got fed up and asked for a raise on the PTSD, the C&P Psychiatrist wrote in his Report, "I am ordering this patient to stop work immediately, he is totally and permanently disabled from PTSD." Meanwhile, my Board Certified Rheumatologist had gotten my AS approved as permanently aggravated by my job duties. He had been trying to get me to stop work for some time....so the day I came home from the VA C&P, I turned in papers to the Postal Service for Civil Service Disability, OWCP related total Disability from AS, and I filed for SS Disability. The key is you CANNOT draw Federal OWCP and VA Disability for the SAME condition, so I never mentioned my PTSD on the OWCP application. I also filed for an upgrade to 100% from the VA. The SS approved me within 30 days..no examination..actually I talked to them and told them I knew I had enough quarters for SS Disability, but since I had not paid into SS for the 18 years I had worked under Civil Service, hence not enough RECENT quarters for SS, but I wanted the free Medicare Part A. OWCP and Civil Service approved within 60 days for AS Disability and I chose OWCP since it paid more and the VA approved 100% PTSD within 60 days. So their screwing me all those years turned into my benefit financially, since I then had 100% for AS under OWCP and 100% for PTSD under VA and by law they both had to pay. OWCP and Blue Cross, which I kept, both agreed to pay for the Embril, but I go for 6 weeks physical therapy about 3 times a year, OWCP paid to add a room on to my my house and paid for the hotub to go in it, they bought me an adjustable, raise up and down, and massage type bed. They purchased a tens unit, and I still take nsaids and approx 4 percocet a day...the pain gets old and at times it's very very hard, but I keep holding on...I can't do anything, but that grows on you too. I was told that AS sometimes settles down after some years, but I have had it since 1970, diagnosed in 1980 and it has never faded out with me. I still say it was from the bacteria, nasty water, chemicals, etc etc and or either from the schrapnel, but now it doesn't matter anymore where it came from...I'm stuck with it. Good luck with your treatments! The best thing to do is probably contact your VAMC and talk to the Cheif of Pharmacy and see what he says about it, since it FDA approved treatment, if your doctor pushes it, it can probably be gotten through the VA.

#5 Pete53

 
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Posted 18 April 2008 - 08:03 PM

You can call any VAMC and ask the Pharmacy what their policy is. Cause it is so expensive I bet that they will either require a specific Doc to write your prescription or will say no it is not on the formulary. In that case if you have your treating Doc write that a substitute is not acceptable and you need the med they will have to prescribe it to you. When you get out no matter what your rating I think the VA has to treat you with no copays.

Good Luck


#6 RayH

 
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Posted 21 April 2008 - 09:07 AM

Thanks,
I will call the VAMC and inquire.

#7 ruby

 
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Posted 30 April 2008 - 08:49 PM

I am assuming all VA's are the same but I believe that may not be incorrect. I know the Tampa VA carries both. You have to have tried and failed all other meds it takes about 4 weeks to get approved.

I got it but decided not to use it. I am a diabetic and have frequent infections with another disease process.