Minor aches and pains in joints are common as people age. Normal wear and tear, as well as an increased likelihood of joint trauma over the course of one’s lifetime, add up over the years. While most people can simply take over-the-counter pain relievers to deal with these issues, some people experience a more serious joint ailment that can become debilitating: rheumatoid arthritis. Unlike traditional arthritis, a condition that causes pain and stiffness due to joint inflammation, rheumatoid arthritis occurs when the immune system attacks the body’s joints. Left untreated, rheumatoid arthritis can lead to redness, swelling, severe pain, limited mobility and even joint deformity.
How is Rheumatoid Arthritis Diagnosed and Treated?
Most patients will schedule a doctor’s appointment after noticing the physical signs of rheumatoid arthritis. These may come on slowly with time or patients may experience flares of symptoms. When visiting a physician, the patient will be physically examined and blood tests may be performed. If rheumatoid arthritis is suspected, the patient may also need to undergo x-rays or an MRI scan in order to show more details regarding a joint’s functionality.
Once a diagnosis has been made, the first line of treatment often involves pain management and physical therapy. Usually, over-the-counter anti-inflammatory drugs are recommended to see if symptoms can be controlled without resorting to prescriptions. Various stretching routines may help keep joints flexible while reducing inflammation. If these methods are not effective, prescription medications like Enbrel may be ordered.
What is Enbrel?
Enbrel (etanercept) is a biologic response modifier medication that is injected and works to mitigate the effects of certain conditions using the body’s own responsiveness within the immune system. It has been shown to be effective in treating rheumatoid arthritis, but it can also come with the risk of infection and the development of blood clots, so patients need to be carefully monitored while taking Enbrel. The drug binds to specific proteins by recombining receptors in the body that produce the inflammation leading to rheumatoid arthritis symptoms.
Does Medicare Cover Enbrel?
Because the drug is relatively new and is only for use in specific patients, it is usually classified as a specialty drug when it comes to Medicare coverage. This means that Enbrel is likely covered by Medicare Part D but may be covered at a reduced rate. Some people have reported only receiving coverage of up to 33% of the cost of the drug, and this can be an issue for some patients as Enbrel is fairly expensive.
Coverage may also depend on the reason for the prescription and whether or not it is being used to treat a condition that is causing harm to overall health. Because Enbrel may be prescribed to address concerns like plaque psoriasis, a skin condition caused by an immune response, you may need to work with your doctor and Medicare insurance plan manager to ensure coverage.