Enbrel® Medicare Coverage

Enbrel®
Chemical name: Etanercept

Typical dosage: 50mg

Typical type: Injection1

Enbrel® is a medication typically used to treat ankylosing spondylitis, plaque psoriasis, juvenile arthritis, psoriatic arthritis and rheumatoid arthritis. It is only available as a brand name medication and is a subcutaneous injection.

Enbrel is a prescription medication that contains the active ingredient Etanercept. Enbrel is typically taken once to twice weekly and is injected subcutaneously into the fatty part of the skin.

Enbrel blocks the actions of a receptor called TNF-alpha to reduce inflammation and relieve symptoms.

The major side effects of Enbrel include irritation at the injection site, diarrhea, headache, runny nose, stuffy nose and throat irritation.

Does Medicare cover Enbrel?

Yes! 76% of Medicare Advantage plans and Medicare Part D plans cover Enbrel.1

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.2

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Enbrel.

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Average costs for Enbrel with Medicare drug coverage1

Your copay and deductible costs for any prescription drug can vary depending on what coverage stage you’re in.

Deductible stage Typical copay stage
Your deductible is the amount of money you must spend on covered drugs before your Medicare drug coverage starts paying its share of costs.

In the deductible stage, you’re responsible for the full cost of your prescription drugs.

Some Medicare prescription drug plans have a $0 deductible. Medicare drug plans cannot have a deductible more than $415 in 2019.
After you meet your Part D deductible, you enter the initial coverage period.

During this phase (the typical copay stage), you pay a copayment (flat fee) or coinsurance (percentage) for your covered medications.
$1,166 – $5,950 $1,166 – $5,950

Additional information

You should be up to date on your immunizations before starting Enbrel.

Enbrel may increase the risk for serious infections, which may result in hospitalization or death. Infections usually develop in patients receiving other immunosuppressive agents while taking Enbrel.

Active tuberculosis, invasive fungal and bacterial and viral infections have been reported. If you are taking Enbrel, watch for signs and symptoms of infection during and after treatment.

Wash your hands often and stay away from people who are sick. This drug should be stopped if you develop a serious infection or sepsis.

Lymphoma and other malignancies have been reported in children and adolescents taking Enbrel. This medication should be used with caution in patients with alcoholic hepatitis, heart failure and seizure disorders.

Women who are pregnant or breastfeeding should talk to their doctor about the risks and benefits of Enbrel before starting this medication. Benzoyl alcohol is occasionally used in the diluent for injection and can be toxic to newborns and fetuses.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

1 GoodRx. Enbrel. Retrieved May 2019, from www.goodrx.com/enbrel.

2 Jacobson, Gretchen; et al. A Dozen Facts About Medicare Advantage. (Nov. 13, 2018). Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.