Does SelectHealth Cover Enbrel

Explore SelectHealth's Enbrel coverage, costs without insurance, potential coverage denials, and tips to secure Enbrel through SelectHealth.
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“Curex is changing the landscape of allergies in 2024”
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SelectHealth Coverage for Enbrel

 

  • SelectHealth may cover Enbrel under specific circumstances, typically requiring a prescription from a specialist for conditions such as rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis.
  •  

  • Coverage often demands prior authorization. This means your healthcare provider must demonstrate the medical necessity, documenting that Enbrel is appropriate for your condition.
  •  

  • Patients must usually have tried and failed to respond adequately to less expensive medications, meaning Enbrel is considered step therapy by many plans.
  •  

  • Copayments and coinsurance amounts can vary based on the specific policy. Review your plan details to understand out-of-pocket costs.
  •  

  • Check the SelectHealth formulary, as Enbrel should be listed as an approved drug for coverage, subject to benefit terms.

 

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Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Enbrel Coverage with SelectHealth

 

Contact SelectHealth Member Services

 

  • Locate your SelectHealth member ID card and have it ready for reference when you reach out to Member Services.
  •  

  • Call the SelectHealth Member Services number listed on your ID card to inquire about coverage for Enbrel.
  •  

  • Request specific information about your plan’s prescription drug coverage and any prerequisites for Enbrel.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity of Enbrel for your condition.
  •  

  • Request a prescription for Enbrel and any required medical documentation to support prior authorization, if necessary.

 

Review Your Plan's Formulary

 

  • Access the SelectHealth formulary online to verify if Enbrel is listed as a covered medication.
  •  

  • Identify any specific requirements such as prior authorization, step therapy, or preferred pharmacy networks for Enbrel.

 

Submit Prior Authorization (if required)

 

  • If Enbrel requires prior authorization, work with your healthcare provider to complete the necessary forms.
  •  

  • Ensure all required information and supporting documents are included in the prior authorization request.
  •  

  • Submit the completed request to SelectHealth for review and approval.

 

Understand Co-Payment or Co-Insurance Obligations

 

  • Review your SelectHealth plan benefits to understand the co-payment or co-insurance cost associated with Enbrel.
  •  

  • Determine if there are any annual out-of-pocket maximums that could affect your total cost.

 

Explore Financial Assistance Programs

 

  • Investigate financial assistance programs or manufacturer coupons for Enbrel to help offset costs.
  •  

  • Contact Enbrel Support or your healthcare provider for guidance on available assistance programs.

 

Verify Pharmacy Coverage

 

  • Confirm that your chosen pharmacy, whether local or mail-order, is within the SelectHealth network.
  •  

  • Discuss with the pharmacy about their process for handling specialty medications like Enbrel to ensure timely dispensing.

 

Monitor and Follow-Up

 

  • Keep regular contact with SelectHealth and your provider to monitor the status of any pending authorizations.
  •  

  • Immediately address any issues or denials by appealing decisions or providing additional documentation if needed.

 

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Does SelectHealth Cover Enbrel

Explore SelectHealth's Enbrel coverage, costs without insurance, potential coverage denials, and tips to secure Enbrel through SelectHealth.
Curex allergy drops unboxing

Is Enbrel Covered by SelectHealth

 

SelectHealth Coverage for Enbrel

 

  • SelectHealth may cover Enbrel under specific circumstances, typically requiring a prescription from a specialist for conditions such as rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis.
  •  

  • Coverage often demands prior authorization. This means your healthcare provider must demonstrate the medical necessity, documenting that Enbrel is appropriate for your condition.
  •  

  • Patients must usually have tried and failed to respond adequately to less expensive medications, meaning Enbrel is considered step therapy by many plans.
  •  

  • Copayments and coinsurance amounts can vary based on the specific policy. Review your plan details to understand out-of-pocket costs.
  •  

  • Check the SelectHealth formulary, as Enbrel should be listed as an approved drug for coverage, subject to benefit terms.

 

A weight management program tailored to you

Start with Curex

SelectHealth's Approved Criteria for Enbrel Coverage

 

Enbrel Coverage Criteria

 

  • SelectHealth provides coverage for Enbrel if it is prescribed by a healthcare provider for the treatment of specific inflammatory conditions that have shown to be responsive to Enbrel therapy.
  •  

  • Eligible conditions include rheumatoid arthritis in patients who have had significant therapeutic responses previously with Enbrel or who have tried and failed other disease-modifying antirheumatic drugs (DMARDs).
  •  

  • Psoriatic arthritis patients are eligible if they demonstrate an inadequate response to prior treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs) or DMARDs.
  •  

  • Patients with ankylosing spondylitis may qualify when they have active disease despite previous treatment attempts with conventional therapies.
  •  

  • Juvenile idiopathic arthritis cases are considered for children above certain age thresholds who have not responded adequately to one or more DMARDs.
  •  

  • Coverage is also extended to patients with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy and have tried other treatments without success.
  •  

  • Documentation of the disease's impact on the patient's daily function and quality of life, as well as evidence of prior therapeutic attempts, must accompany the prescription request.
  •  

  • SelectHealth requires that Enbrel therapy be requested and monitored by a specialist experienced in the diagnosis and management of the specific inflammatory condition.
  •  

  • Continuation of therapy necessitates periodic review of the patient's response to treatment, with documentation supporting continued medical necessity.

 

Why SelectHealth Might Deny Enbrel Coverage

 

Situations Where SelectHealth Does Not Cover Enbrel

 

  • Patient does not meet the required age criteria specified by SelectHealth policies.
  •  

  • The medication is being used for a condition not approved by the FDA or specified in SelectHealth's formulary guidelines.
  •  

  • Patient has not tried and failed the required number of alternative therapies before requesting Enbrel.
  •  

  • The prescription is from a provider not within the SelectHealth network or not authorized under their plan.
  •  

  • Request for Enbrel is outside the plan’s covered indications without prior authorization.
  •  

  • Enbrel is being prescribed at a dosage or frequency not aligned with approved standards.
  •  

  • Patient lacks a documented, confirmed diagnosis that justifies the use of Enbrel as per SelectHealth’s clinical criteria.
  •  

  • The treatment duration exceeds what is considered medically necessary according to SelectHealth's policy.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Enbrel Cost without Insurance?

 

Approximate Cost of Enbrel Without Insurance

 

  • The approximate cost of Enbrel, an injection used to treat autoimmune conditions such as rheumatoid arthritis and psoriasis, is generally around $5,000 to $7,000 per month without insurance.
  •  

  • This monthly cost can vary depending on the dosage prescribed and the specific pharmacy location.
  •  

  • Patients may be able to find some cost reduction through manufacturer discounts or assistance programs, but these are typically separate from traditional insurance coverage.
  •  

  • Comparing pharmacy prices through services or websites that provide drug price comparisons may help in finding the lowest available price.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Enbrel Coverage with SelectHealth

 

Contact SelectHealth Member Services

 

  • Locate your SelectHealth member ID card and have it ready for reference when you reach out to Member Services.
  •  

  • Call the SelectHealth Member Services number listed on your ID card to inquire about coverage for Enbrel.
  •  

  • Request specific information about your plan’s prescription drug coverage and any prerequisites for Enbrel.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity of Enbrel for your condition.
  •  

  • Request a prescription for Enbrel and any required medical documentation to support prior authorization, if necessary.

 

Review Your Plan's Formulary

 

  • Access the SelectHealth formulary online to verify if Enbrel is listed as a covered medication.
  •  

  • Identify any specific requirements such as prior authorization, step therapy, or preferred pharmacy networks for Enbrel.

 

Submit Prior Authorization (if required)

 

  • If Enbrel requires prior authorization, work with your healthcare provider to complete the necessary forms.
  •  

  • Ensure all required information and supporting documents are included in the prior authorization request.
  •  

  • Submit the completed request to SelectHealth for review and approval.

 

Understand Co-Payment or Co-Insurance Obligations

 

  • Review your SelectHealth plan benefits to understand the co-payment or co-insurance cost associated with Enbrel.
  •  

  • Determine if there are any annual out-of-pocket maximums that could affect your total cost.

 

Explore Financial Assistance Programs

 

  • Investigate financial assistance programs or manufacturer coupons for Enbrel to help offset costs.
  •  

  • Contact Enbrel Support or your healthcare provider for guidance on available assistance programs.

 

Verify Pharmacy Coverage

 

  • Confirm that your chosen pharmacy, whether local or mail-order, is within the SelectHealth network.
  •  

  • Discuss with the pharmacy about their process for handling specialty medications like Enbrel to ensure timely dispensing.

 

Monitor and Follow-Up

 

  • Keep regular contact with SelectHealth and your provider to monitor the status of any pending authorizations.
  •  

  • Immediately address any issues or denials by appealing decisions or providing additional documentation if needed.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Enbrel FAQ

What conditions does Enbrel treat?

 

Conditions Treated by Enbrel

 

  • Rheumatoid Arthritis: Enbrel is commonly used for treating moderate to severe rheumatoid arthritis in adults, helping to reduce joint pain and swelling.
  • Juvenile Idiopathic Arthritis: Effective for kids aged 2 and older, Enbrel helps manage symptoms of juvenile idiopathic arthritis.
  • Psoriatic Arthritis: Patients with psoriatic arthritis can benefit from Enbrel, as it alleviates joint and skin symptoms.
  • Ankylosing Spondylitis: It aids in managing stiffness and inflammation linked to ankylosing spondylitis.
  • Plaque Psoriasis: Enbrel is used for treating moderate to severe plaque psoriasis in adult patients, reducing skin lesions.

 

What are common side effects of Enbrel?

 

Common Side Effects of Enbrel

 

  • Injection Site Reactions: Pain, redness, and swelling at the injection site are quite common.
  •  

  • Infections: Users may experience an increased risk of infections, including upper respiratory tract infections.
  •  

  • Headache: Some patients report headaches following administration.
  •  

  • Nausea and Vomiting: These gastrointestinal issues can occur.
  •  

  • Rash: Skin reactions such as rashes are noted in some individuals.
  •  

  • Heartburn: Stomach discomfort and heartburn are possible.

 

Be sure to consult your healthcare provider for any concerning symptoms or persistent side effects.

How is Enbrel administered?

 

Administration of Enbrel

 

  • Enbrel is administered via subcutaneous injection.
  • It is typically provided in a prefilled syringe, autoinjector (SureClick), or a vial requiring reconstitution.
  • Injections are usually administered on the thigh, abdomen, or outer area of the upper arm.
  • It's crucial to rotate the injection sites to avoid irritation.

 

Preparation and Injection

 

  • Check the solution for particles or discoloration before use.
  • If needed, allow the solution to reach room temperature for about 15–30 minutes.
  • Wash your hands thoroughly before handling the medication.
  • Use an alcohol swab to clean the injection site.
  • Inject Enbrel by angling the needle at 90 degrees for optimal delivery.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide. Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

Does SelectHealth Cover Enbrel

Explore SelectHealth's Enbrel coverage, costs without insurance, potential coverage denials, and tips to secure Enbrel through SelectHealth.
Curex allergy drops unboxing

Does SelectHealth Cover Enbrel

 

SelectHealth Coverage for Enbrel

 

  • SelectHealth may cover Enbrel under specific circumstances, typically requiring a prescription from a specialist for conditions such as rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis.
  •  

  • Coverage often demands prior authorization. This means your healthcare provider must demonstrate the medical necessity, documenting that Enbrel is appropriate for your condition.
  •  

  • Patients must usually have tried and failed to respond adequately to less expensive medications, meaning Enbrel is considered step therapy by many plans.
  •  

  • Copayments and coinsurance amounts can vary based on the specific policy. Review your plan details to understand out-of-pocket costs.
  •  

  • Check the SelectHealth formulary, as Enbrel should be listed as an approved drug for coverage, subject to benefit terms.

 

A weight management program tailored to you

Start with Curex

Why SelectHealth Might Deny Enbrel Coverage

 

Enbrel Coverage Criteria

 

  • SelectHealth provides coverage for Enbrel if it is prescribed by a healthcare provider for the treatment of specific inflammatory conditions that have shown to be responsive to Enbrel therapy.
  •  

  • Eligible conditions include rheumatoid arthritis in patients who have had significant therapeutic responses previously with Enbrel or who have tried and failed other disease-modifying antirheumatic drugs (DMARDs).
  •  

  • Psoriatic arthritis patients are eligible if they demonstrate an inadequate response to prior treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs) or DMARDs.
  •  

  • Patients with ankylosing spondylitis may qualify when they have active disease despite previous treatment attempts with conventional therapies.
  •  

  • Juvenile idiopathic arthritis cases are considered for children above certain age thresholds who have not responded adequately to one or more DMARDs.
  •  

  • Coverage is also extended to patients with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy and have tried other treatments without success.
  •  

  • Documentation of the disease's impact on the patient's daily function and quality of life, as well as evidence of prior therapeutic attempts, must accompany the prescription request.
  •  

  • SelectHealth requires that Enbrel therapy be requested and monitored by a specialist experienced in the diagnosis and management of the specific inflammatory condition.
  •  

  • Continuation of therapy necessitates periodic review of the patient's response to treatment, with documentation supporting continued medical necessity.

 

Together with our partners we have changed the lives of over 300,000 patients.

Enbrel FAQ

 

Situations Where SelectHealth Does Not Cover Enbrel

 

  • Patient does not meet the required age criteria specified by SelectHealth policies.
  •  

  • The medication is being used for a condition not approved by the FDA or specified in SelectHealth's formulary guidelines.
  •  

  • Patient has not tried and failed the required number of alternative therapies before requesting Enbrel.
  •  

  • The prescription is from a provider not within the SelectHealth network or not authorized under their plan.
  •  

  • Request for Enbrel is outside the plan’s covered indications without prior authorization.
  •  

  • Enbrel is being prescribed at a dosage or frequency not aligned with approved standards.
  •  

  • Patient lacks a documented, confirmed diagnosis that justifies the use of Enbrel as per SelectHealth’s clinical criteria.
  •  

  • The treatment duration exceeds what is considered medically necessary according to SelectHealth's policy.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How Much Does Enbrel Cost without Insurance?

 

Approximate Cost of Enbrel Without Insurance

 

  • The approximate cost of Enbrel, an injection used to treat autoimmune conditions such as rheumatoid arthritis and psoriasis, is generally around $5,000 to $7,000 per month without insurance.
  •  

  • This monthly cost can vary depending on the dosage prescribed and the specific pharmacy location.
  •  

  • Patients may be able to find some cost reduction through manufacturer discounts or assistance programs, but these are typically separate from traditional insurance coverage.
  •  

  • Comparing pharmacy prices through services or websites that provide drug price comparisons may help in finding the lowest available price.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.