Beginning Jan. 1, 2015, UnitedHealthcare will move etanercept (Enbrel) to a “double-step” policy that requires new patients to try and fail 2 other designated biologics before taking the drug. Additionally, UnitedHealthcare’s Specialty Pharmacy network will no longer accept copay assistance coupons or cards as payment for etanercept, according to the National Psoriasis Foundation.
Under this new policy, current etanercept users may see an increase in their copay at the pharmacy counter. Users will be required to pay the out-of-pocket cost for their etanercept prescription, and can be reimbursed through the drug manufacturer. If patients who have psoriasis are covered by UnitedHealthcare and their physician determines they should be treated with etanercept, patients will be required to try and fail both adalimumab (Humira) and (ustekinumab) Stelara first.
For patients with psoriatic arthritis who are covered by UnitedHealthcare and their physician determines they should be treated with etanercept, they will be required to try and fail 2 of the 4 medications on the second tier that are approved for psoriatic arthritis: certolizumab pegol (Cimzia), adalimumab, golimumab (Simponi) and ustekinumab.
Copay assistance is still available after purchase of etanercept by applying for copay reimbursement through the manufacturer. For more information on this new reimbursement process, please contact an Enbrel Support reimbursement counselor at call 1-888-4ENBREL (1-888-436-2735).
