Enbrel Cost with Part D

I have been talking to two people using the drug Enbrel who were shocked and disappointed to learn how expensive Enbrel will be when they get on Medicare and sign up for Part D drug coverage.

ENBREL is a prescription medicine that can be self-injected. It is used to treat moderate to severe rheumatoid arthritis (RA), adult chronic moderate to severe plaque psoriasis, and other inflammatory diseases.  Enbrel is expensive and, under Medicare Part D, it is considered a “specialty drug”.  That means the co-pay is 33% – and a person will go into the coverage gap/donut hole very quickly.

Enbrel cost with Part D

To find a Part D plan for clients, I put their prescriptions into the Medicare.gov Plan Finder.  On every plan, Enbrel comes in at a retail price of $2,900 per month.

The Plan Finder shows that a person will go into the donut hole/coverage gap in month 2 and into the catastrophic stage in month 3.  That means my clients would spend over $2,800 in the first three months and then they get big relief when they pay only 5% of the cost in the catastrophic stage.

But here’s the rub.  Both of my client’s have had employer coverage and their co-pay has been around $10 for Enbrel.  Once they stop working and get on Medicare, their cost will be over $4,400!  Their employer coverage doesn’t have a donut hole and, according to one client, the actual cost of Enrbrel is around $600 on his employer plan.

So why is the retail cost to Part D so high?  The law that created Part D says only insurance companies can negotiate Part D drug prices with pharmaceutical companies.  The government is forbidden to negotiate, or set prices.   But Medicare is actually paying the bill for Part D plans!!

Here is what came up in Medicare.gov Plan Finder.  There are 29 Part D plans offered in Arizona.

 

retail cost

 

 

 

 

 

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The costs on each sheet are a bit different because one is for one client and the other is for the other client – and they are two different Part D plans.

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5 Responses to "Enbrel Cost with Part D"

  1. Walter L. Godek Jr says:

    So glad that you are concerned about the costs involved for drugs. I am a 68 year old retiree that basically has stayed out of the medical professions “Capture loop”. I have been on Medicare for 3 years and have used it once. I have recently been diagnosed with moderate plaque psoriasis which I have treated myself for about 5 years. I got tired of flaking and made the mistake of going to a doctor. You could imagine my reaction to drug costs, never having been exposed before. The world has gone insane around me. Being that I sort of improve every summer, I’m going to go to a tanning salon and try it. Honestly, when my time comes I’m going directly to hospice, I’ll probably live longer and better there anyway.

  2. Denise says:

    The cost of drugs is ridiculous and Americans are being gouged. I live one hour from the border with Mexico and I will be heading south if I need a brand drug. I think I will make a triip soon and ask about the price for Enbrel in Mexico. I have been told by clients who shop in Mexico that insulin and expensive drubs like Eloquis and Victoza are 50% to 80% lower in Mexico.

  3. RITA says:

    I am on Enbrel and thankfully will be able to keep my insurance when I retire. but I would like to point out that there is no generic for Enbrel: I have been taking it for 20 years, when it first came out, for severe rheumatoid arthritis. the only medicine that works for me. but Johnson and Johnson hold the patent for it and it has never been released, why is that? the patent should have run out years ago, allowing other drug companies to make it then the cost becomes competitive and prices go down. why hasn’t this happened? they certainly should have regained their research drug cost long ago.

  4. MikeW says:

    I have the same problem as I am on Medicare. Living on a teachers pension and social security my costs via Part D Medicare for Embrel is $950 for month 1, $1500 for month 2, $950 for month 3 and then $175 a month for the next 9 months then it starts all over again. Totally unaffordable for me. Same problem with Celebrex. I have the AARP plan and generic Celebrex is not in the formulary forcing me to pay retail of over $200 a month. Luckily I discovered Blink Health and am getting the prescription for $61 a month. Prescription drug costs are preventing seniors on Medicare from getting the drugs they need or forcing them into the poor house to pay for them. Medicare needs to be able to negioate better drug prices.

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