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Cost of Enbrel with insurance?

  • By syzygy

    Hi all, I know this is a pretty personal question but you would ease my mind greatly. I am on Enbrel and MTX, and I get Enbrel through the AmGen Safety Net Foundation (for those of you who don’t know what that is, it covers your medication if you have insurance that doesn’t cover the prescription and your income is low enough).

    However, I just finished my graduate degree and I’m applying for jobs. I will likely get medical coverage through an employer that covers Enbrel but at what cost? I’m so worried it will no longer be something I can afford. It’s changed my life, though. As in, without it, I wouldn’t be able to work at all.

    I know it will vary a lot, but if you wouldn’t mind sharing your monthly Enbrel cost on employer-covered health insurance, that would be incredible. Basically, I’m torn between taking a job I’d love at ridiculously low pay (and maybe sacrificing Enbrel??) or pushing for something at a much higher level of pay that I’d hate. I’d rather make much less money and do something I love provided that I can still afford my meds.

    Thank you!!

    reply
  • By Lawrence 'rick' Phillips Moderator

    You raise a question we cannot really answer, because there are so many variables. But here is what a beginning teacher in central Indiana school system pays for Enbrel.

    To start a beginning teacher will make about 35K per year with no masters degree and no experience. They woudl likely take the best health plan offered, and they woudl pay about 3.5K for the plan. Then the cost of the Enbrel on such a plan would be about 5k per month.

    Of that the teacher would pay the first $200, plus 15% up to 3K, after that it woudl be $0.00 for the year.

    Total cost per year about $3,200 plus cost of health insurance. Now remember a teacher is paid for 182 days of school per year. In this case it would be tough the first year, but with prescription discount cards, you woudl make it no issue.

    Here is a better way to figure this out. Before you accept a job offer ask about cost of health insurance, and get plan outline. It is customary to ask for 48 hours to consider the offer. Let them know you must look over the health insurance options before you give an answer. Also customary.

    By and large if you are up front with personnel they can help you figure this out. Remember the job has been offered so they will not withdraw the offer or be overly concerned when you talk to personnel.

    Every employer is different, but this will be OK, I promise.

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  • By syzygy

    Hi Rick, thanks for your very informative reply. Yes, I know that no one can tell me what to expect. I was merely trying to get an idea of what the landscape looks like.

    For clarification, there is no job offer. I have a PhD in a field that would enable me to either stay in academia (my preference) or pursue the private sector. Private sector comes with better insurance and sometimes drastically better pay. However, I would be miserable. I don’t care about the pay as long as my bills are covered. But I’m trying to get a sense for if I can afford Enbrel on an entry-level academic’s salary. I have polled friends and colleagues and know what to expect for premiums but none of them can tell me about coverage for something like Enbrel. Enbrel is negotiated with most insurers at $5-6k per month. Most private insurance plans in my price point have a $5k deductible, which means I’d have to pay for an entire month upfront before it’s covered at 75% level. But 25% of $6000 is still $1500 per month! I can’t afford that on an academic’s salary. Granted, as an academic I wouldn’t have private insurance but I’m using this as reference and maybe my “worst case scenario”. The picture you paint is far better than I feared.

    This is why I am trying to gauge if the employer-provided insurance landscape is any more optimistic. I could probably afford up to $800 per month but that would require a second parttime job.

    So, my dilemma is if I forgo what I love and head to the private sector. Obviously, I can’t really make that decision until I can see the benefits offered to me. But I thought I would ask and see what others have experienced. I’m at a pivotal point in my career, and what I choose next dictates my trajectory to some extent. Unfortunately, it may not be only about doing what I want and love. I may have to choose what’s most pragmatic for health coverage.

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    • By Lawrence 'rick' Phillips Moderator

      In the short run you should not discount the availability of pharma discount programs. Chances are good that for the immediate future you (perhaps 12 months) you will likely qualify for the card. There is a wrinkle here, but for another day.

      The great advantage is that if you are considering a public university you can see their health plans prior to even applying. So call a few public universities int eh area you want to work and let them knwo you are doing research, ask for a copy of statement of benefits. They will direct you to it. By and large private U’s will be similar.

      Also you should not discount the advantage of pretax medical expenses. In a case like this you would likely want to use the pretax benefit for payment of these medical expenses. This is called Section 125. Given federal, state and local tax payments you might save as much as 20% of the cost of the medical expense, it is a lot when pinching pennies.

      Here is an explanation of section 125 plans.

      https://www.peoplekeep.com/blog/how-section-125-cafeteria-plans-work

      Oh and depending on you specialty you may find other benefits. Like co research etc.

      Finally be sure and apply at Indiana University, the greatest University in the whole world, but I might be slightly bias, just saying. Oh and heck Nova Southeastern in Ft. Lauderdale FL is a great place as well.

      reply