Shields "Care Corner" Blog

How We Saved an Arthritis Patient $34,000 After She Lost Her Insurance

From the Hospital Specialty Pharmacy Team: One of our Rheumatoid Arthritis patients, Aliyah, lost her insurance and our specialty pharmacy team was asked by the clinic physician, Dr. Patel, to see if we could somehow find a way to get her started on Enbrel® immune system therapy without the support of insurance.


Immediately the team set out to get Aliyah a bridge supply of Enbrel, which was generously donated by the manufacturer, Amgen®.  With that supply in place, we started to fight for eligibility through Medicaid and Medicare. We worked with the patient and her Department of Health and Human Services case worker to get the necessary applications submitted. We expected denials and we got them. But we planned ahead and started gathering the physician’s appeals letters and medical-necessity research information ahead of time.  So we re-processed the eligibility claims and won the appeal right away! 


From May 2nd through September 20th Aliyah received free medication, including multiple samples from the clinic.  As of today, our team of patient advocates, financial assistance experts and a patient liaison in the clinic got Aliyah access to new insurance coverage and another 9 weeks of free medication to maintain her therapy.


At a cash price of almost $5,000 for 7 months of treatment, we were able to save Aliyah more than $34,000 in medication costs. The best part? She didn’t miss a dose.

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