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Step 1

Get personalized support services—all at no cost to you

The ENBREL Support Program gives you answers, assistance, and services to help you start and stay on track with ENBREL.

  • One-on-one support from registered nurses and insurance specialists

  • Injection and refill reminders to keep ENBREL on your schedule

  • Travel pack to store ENBREL on-the-go

  • Needle disposal containers sent right to your door

*Required information.
*Please select a condition
Step 2

Get personalized support services—all at no cost to you

Please tell us which services you'd like to receive. You can choose all the support services, or just select specific ones.

Need to renew or replace your co-pay card? Renew or replace now

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Co-pay card

The ENBREL Support™ Co-Pay Card helps lower the cost of ENBREL for eligible patients.

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Activating a card?

Please enter the [x]-digit card number here:

Step 8

Review your selected support services

You selected the following services
  • Co-pay card
  • Needle disposal containers
  • Reminders to inject and refill ENBREL

There is a problem with the number you have entered. Please double check the ID or if you would like we can generate a new card for you.

Activating a card?
Please enter the [x]-digit card number here:

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Or, call 1-888-4ENBREL (1-888-436-2735)

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Step 3

Check your eligibility

*Required information.
You selected the following services
  • Co-pay card
  • Needle disposal containers
  • Reminders to inject and refill ENBREL
Tell us about yourself

*Date of Birth

* Are you (or the patient) a resident of one of the 50 United States or Puerto Rico, or a U.S. territory?

* Are you enrolled in a health plan purchased through the federal Health Insurance Marketplace at healthcare.gov, or a State Exchange such as Covered California or the NY State of Health, with health insurance coverage after January 1, 2014?

* Do you have commercial or private healthcare insurance?

* Is your ENBREL prescription paid for, in whole or in part, by any i) federal government funded healthcare program, such as Medicare Part B or D, Medicare Advantage, Medicaid, Medigap, Veterans Affairs (VA), the Department of Defense (DoD), or TRICARE or ii) any similar state funded program such as a state pharmacy assistance program?

* The ENBREL Support™ Co-pay Card is only valid for patients with commercial or private insurance whose ENBREL is not paid for or reimbursed, in whole or in part, by any federal, state or government-funded healthcare program and you must have prescription drug coverage with a commercial or private healthcare insurance carrier to be eligible for this program. If at any time you begin receiving prescription drug coverage under any such federal, state or government-funded healthcare program, you will no longer be eligible to participate in the ENBREL Support™ Co-pay Card and you may no longer use this card.

Do you agree with this statement? (You must agree in order to be eligible.)

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Step 3 Error Age

Check your eligibility

You selected the following services
  • Co-pay card
  • Needle disposal containers
  • Reminders to inject and refill ENBREL
We're Sorry.

You must be 18 or older to receive ENBREL Support™ services.

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Cancel
Step 3 Error government

Check your eligibility

You selected the following services
  • Co-pay card
  • Needle disposal containers
  • Reminders to inject and refill ENBREL
We're Sorry.

Based on the information you gave us, you are not eligible for the ENBREL Support™ Co-pay Card. However, you can still get all the other benefits of the ENBREL Support™ program.
If you’d like to learn about other options that may help you pay for ENBREL, please call us at 1-888-4ENBREL (1-888-436-2735).

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Step 6

Tell us about yourself

*Required information.
You selected the following services
  • Co-pay card
  • Needle disposal containers
  • Reminders to inject and refill ENBREL
Tell us about yourself

I give Amgen permission to leave a voice message and/or send me an SMS/text that refers to the ENBREL Support™ program by name and may include personal health information about my condition or treatment.

Specialist
PHYSICIAN INFORMATION
Prescription Information

* Do you have an ENBREL prescription?

* Have you started treatment?

*Start Date

Vibrant Lives is a voluntary program that gives you the opportunity to tell your personal story. Would you like to learn more?

Refill Information

How often do you refill your prescription?

Please select the date you would like your first refill reminder to come

Injection Information

Please select your start date or approximate start date.

Privacy Notice and Authorization

Uses and Disclosure of Personal Information

I authorize Amgen and its contractors ("Amgen") to use and/or disclose my personal information, including my personal health information, for the following purposes:

To enroll me in and/or continue my participation in Amgen's ENBREL Support™ program or any other Amgen-affiliated patient support services and related activities (for example, the option to join the ENBREL Sharps Mail-Back Program to receive sharps disposal containers, co-pay card programs, reimbursement assistance programs, drug coverage verification, nurse educator services and disease management support);

To provide me with informational and marketing materials relating to Amgen products and services, and/or my condition or treatment; and/or

To improve, develop, evaluate and continue products, services, materials and programs related to my condition or treatment.

I also authorize any health care providers, health care plans, pharmacies, pharmaceutical companies, laboratories and/or their contractors ("Health Care Providers") to disclose any of my personal health information to Amgen as requested by Amgen and as necessary for the purposes stated in this Authorization.

I understand that my personal health information includes any information, in electronic or physical form, in the possession of or derived from a health care provider, health care plan, pharmacy, pharmaceutical company, and/or contractor regarding: (1) my medical history, including my entire medical file and complete patient history; (2) my health care plan benefits; (3) limits or restrictions on payments covered by my health care plan policy; and/or (4) my health or my adherence to my treatment.

Expiration, Right to Obtain a Copy and Right to Cancel

I understand that Amgen may use my personal information, including my personal health information, for 10 years once I sign this Authorization or for a shorter time period if required by state law. I also understand that I can cancel this Authorization at any time by calling Amgen at 1-888-436-2735. Once Amgen receives and processes my cancellation, it will not use my personal information going forward; however, I understand that cancelling my Authorization will not affect any use of my personal information that occurred before my request was processed. I further understand that if a Health Care Provider is disclosing my personal health information to Amgen on an on-going basis as authorized herein, my cancellation with Amgen will only be effective with respect to any such Health Care Provider once they actually receive notice of my cancellation from Amgen.

No Effect on Treatment

I understand that I do not have to agree to the uses and disclosures of my personal information contained in this Notice and Authorization. I understand that Amgen, as well as Health Care Providers, cannot require me, as a condition of receiving medications, prescription drugs, treatment or other care, to sign this Authorization. However, I also understand that Amgen cannot provide me with any of the services contained in the Notice and Authorization without my authorization, including but not limited to, my enrollment or continued participation in patient support services. Under these circumstances, I may be responsible for the full costs of my treatment.

Information Received from Health Care Providers

I understand that where a Health Care Provider discloses my personal health information to Amgen for the purposes contained in this Notice and Authorization, the personal health information disclosed may not be covered by any federal law relating to the use of my personal health information or how it is disclosed. There is no guarantee that my personal health information received by Amgen from a Health Care Provider might not be released to a third party. I further understand that if a Health Care Provider is disclosing my personal health information on an on-going basis to Amgen, this Authorization only permits Health Care Providers to do so for 1 year once I sign it or a shorter time period if required by state law.

I understand that I may choose to be contacted by Amgen by mail, email, phone, and/or SMS/text for any of the purposes stated in this Authorization and that such communications may include the use of prerecorded voice messages and autodial systems. I further understand that if I allow Amgen to send me an SMS/text or leave a voice message, any such voice message or SMS/text may contain sensitive information regarding Amgen's programs and/or my condition or treatment.

I give Amgen permission to contact me by e-mail, phone, mail, and/or SMS/text message for the purposes detailed in the Privacy Notice above, and to provide me with informational and marketing communications in the future.

By checking the "I accept" box, I am electronically signing this form and indicating I am at least 18 years old and authorize Amgen and its contractors to use and disclose my Personal Information for the purposes described above.

Please note: If you do not want your Personal Information used for the purposes described above, click the Cancel button to discontinue your registration.


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Step 7

Success! You're now enrolled in the ENBREL Support™ Program.

You'll be getting a confirmation email, along with news and information about your condition.

Looking for personal support from a nurse?

Now that you're registered for ENBREL Support™, you have the additional option to enroll in the ENBREL Nurse Partner Program. Learn more and enroll now.

For the specific service(s) you have already requested, here is what you can expect:

ENBREL Support™ Co-Pay Card

Thank you for activating your ENBREL Support™ Co-Pay Card. You can now use your card at the pharmacy when you fill your prescription.

Your ENBREL Support Co-pay Card should arrive in about 3-5 business days. Until then, you can print and use this temporary card.


Needle Disposal Containers

You should get your first gallon-sized needle disposal container in about 7 to 10 business days.

Injection and Refill Reminders

Your reminders will begin on the start date you selected.

If you'd like to talk to a support specialist, please call 1-888-4ENBREL (1-888-436-2735).

  • Registered nurses are available to help you from 8 AM to 11 PM (ET), 7 days a week

  • Insurance specialists are available to help you 8 AM to 8 PM (ET), Monday through Friday

Step 2
We're sorry

There was a system error and we’re not able to process your form.

Please call 1-888-4ENBREL (1-888-436-2735) Monday through Friday, 8 AM to 8 PM (ET) and we’ll be happy to help with any questions you may have.

Please see the full Prescribing Information, Important Safety Information, and Medication Guide for more details about ENBREL.

Prescription Enbrel® (etanercept) is taken by injection.

IMPORTANT SAFETY INFORMATION
What is the most important information I should know about ENBREL?

ENBREL is a medicine that affects your immune system. ENBREL can lower the ability of your immune system to fight infections. Serious infections have happened in patients taking ENBREL. These infections include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections. Your doctor should test you for TB before you take ENBREL and monitor you closely for TB before, during, and after ENBREL treatment, even if you have tested negative for TB.

There have been some cases of unusual cancers reported in children and teenage patients who started using tumor necrosis factor (TNF) blockers before 18 years of age. Also, for children, teenagers, and adults taking TNF blockers, including ENBREL, the chances of getting lymphoma or other cancers may increase. Patients with RA or psoriasis may be more likely to get lymphoma.

Before starting ENBREL, tell your doctor if you:
  • Have any existing medical conditions
  • Are taking any medicines, including herbals
  • Think you have, are being treated for, have signs of, or are prone to infection. You should not start taking ENBREL if you have any kind of infection, unless your doctor says it is okay
  • Have any open cuts or sores
  • Have diabetes, HIV, or a weak immune system
  • Have TB or have been in close contact with someone who has had TB
  • Were born in, lived in, or traveled to countries where there is more risk for getting TB. Ask your doctor if you are not sure
  • Live, have lived in, or traveled to certain parts of the country (such as, the Ohio and Mississippi River valleys, or the Southwest) where there is a greater risk for certain kinds of fungal infections, such as histoplasmosis. These infections may develop or become more severe if you take ENBREL. If you don’t know if these infections are common in the areas you’ve been to, ask your doctor
  • Have or have had hepatitis B
  • Have or have had heart failure
  • Develop symptoms such as persistent fever, bruising, bleeding, or paleness while taking ENBREL
  • Use the medicine Kineret® (anakinra), Orencia® (abatacept), or Cytoxan® (cyclophosphamide)
  • Are taking anti-diabetic medicines
  • Have, have had, or develop a serious nervous disorder, seizures, any numbness or tingling, or a disease that affects your nervous system such as multiple sclerosis or Guillain-Barré syndrome
  • Are scheduled to have surgery
  • Have recently received or are scheduled for any vaccines. All vaccines should be brought up-to-date before starting ENBREL. Patients taking ENBREL should not receive live vaccines.
  • Are allergic to rubber or latex
  • Are pregnant, planning to become pregnant, or breastfeeding
  • Have been around someone with chicken pox
What are the possible side effects of ENBREL?

ENBREL can cause serious side effects including: New infections or worsening of infections you already have; hepatitis B can become active if you already have had it; nervous system problems, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes; blood problems (some fatal); new or worsening heart failure; new or worsening psoriasis; allergic reactions; autoimmune reactions, including a lupus-like syndrome and autoimmune hepatitis.

Common side effects include: Injection site reactions, upper respiratory infections (sinus infections), and headache.

In a medical study of patients with JIA, side effects were generally similar in frequency and type as those seen in adult patients. The kinds of infections reported were generally mild and similar to those usually seen in children.

These are not all the side effects with ENBREL. Tell your doctor about any side effect that bothers you or does not go away.

If you have any questions about this information, be sure to discuss them with your doctor. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see Prescribing Information and Medication Guide.

INDICATIONS
Moderate to Severe Rheumatoid Arthritis (RA)

ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with moderately to severely active rheumatoid arthritis. ENBREL can be taken with methotrexate or used alone.

Moderately to Severely Active Polyarticular Juvenile Idiopathic Arthritis (JIA)

ENBREL is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis (JIA) in children ages 2 years and older.

Psoriatic Arthritis

ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with psoriatic arthritis. ENBREL can be used with or without methotrexate.

Ankylosing Spondylitis (AS)

ENBREL is indicated for reducing signs and symptoms in patients with active ankylosing spondylitis.

Moderate to Severe Plaque Psoriasis

ENBREL is indicated for the treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

IMPORTANT SAFETY INFORMATION
What is the most important information I should know about ENBREL?

ENBREL is a medicine that affects your immune system. ENBREL can lower the ability of your immune system to fight infections. Serious infections have happened in patients taking ENBREL. These infections include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections. Your doctor should test you for TB before you take ENBREL and monitor you closely for TB before, during, and after ENBREL treatment, even if you have tested negative for TB.

There have been some cases of unusual cancers reported in children and teenage patients who started using tumor necrosis factor (TNF) blockers before 18 years of age. Also, for children, teenagers, and adults taking TNF blockers, including ENBREL, the chances of getting lymphoma or other cancers may increase. Patients with RA or psoriasis may be more likely to get lymphoma.

Before starting ENBREL, tell your doctor if you:
What are the possible side effects of ENBREL?

ENBREL can cause serious side effects including: New infections or worsening of infections you already have; hepatitis B can become active if you already have had it; nervous system problems, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes; blood problems (some fatal); new or worsening heart failure; new or worsening psoriasis; allergic reactions; autoimmune reactions, including a lupus-like syndrome and autoimmune hepatitis.

Common side effects include: Injection site reactions, upper respiratory infections (sinus infections), and headache.

In a medical study of patients with JIA, side effects were generally similar in frequency and type as those seen in adult patients. The kinds of infections reported were generally mild and similar to those usually seen in children.

These are not all the side effects with ENBREL. Tell your doctor about any side effect that bothers you or does not go away.

If you have any questions about this information, be sure to discuss them with your doctor. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see Prescribing Information and Medication Guide.

INDICATIONS
Moderate to Severe Rheumatoid Arthritis (RA)

ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with moderately to severely active rheumatoid arthritis. ENBREL can be taken with methotrexate or used alone.

Moderately to Severely Active Polyarticular Juvenile Idiopathic Arthritis (JIA)

ENBREL is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis (JIA) in children ages 2 years and older.

Psoriatic Arthritis

ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting worse, and improving physical function in patients with psoriatic arthritis. ENBREL can be used with or without methotrexate.

Ankylosing Spondylitis (AS)

ENBREL is indicated for reducing signs and symptoms in patients with active ankylosing spondylitis.

Moderate to Severe Plaque Psoriasis

ENBREL is indicated for the treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

  • Close
IMPORTANT SAFETY INFORMATION: What is the most important information I should know about Enbrel® (etanercept)?

ENBREL is a medicine that affects your immune system. ENBREL can lower the ability of your immune system to fight infections. Serious infections have happened in patients taking ENBREL. These infections include tuberculosis(TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections. Your doctor should test you for TB before you take ENBREL and monitor you closely for TB before, during, and after ENBREL treatment, even if you have tested negative for TB.

There have been some cases of unusual cancers reported in children and teenage patients who started using tumor necrosis factor (TNF) blockers before 18 years of age. Also, for children, teenagers, and adults taking TNF blockers, including ENBREL, the chances of getting lymphoma or other cancers may increase. Patients with RA or psoriasis may be more likely to get lymphoma.

Before starting ENBREL, tell your doctor if you:

What are the possible side effects of ENBREL?

ENBREL can cause serious side effects including: New infections or worsening of infections
you already have; hepatitis B can become active if you already have had it; nervous system
problems
, such as multiple sclerosis, seizures, or inflammation of the nerves of the eyes;
blood problems (some fatal); new or worsening heart failure; new or worsening psoriasis;
allergic reactions; autoimmune reactions, including a lupus-like syndrome and autoimmune
hepatitis.

Common side effects include: Injection site reactions, upper respiratory infections (sinus
infections), and headache.

In a medical study of patients with JIA, side effects were generally similar in frequency and type as those seen in adult patients. The kinds of infections reported were generally mild and similar to those usually seen in children.

These are not all the side effects with ENBREL. Tell your doctor about any side effect that
bothers you or does not go away.

If you have any questions about this information, be sure to discuss them with your doctor.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit
www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see Prescribing Information and Medication Guide.

INDICATIONS
Moderate to Severe Rheumatoid Arthritis (RA)

ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting
worse, and improving physical function in patients with moderately to severely active rheumatoid
arthritis. ENBREL can be taken with methotrexate or used alone.

Moderately to Severely Active Polyarticular Juvenile Idiopathic Arthritis (JIA)

ENBREL is indicated for reducing signs and symptoms of moderately to severely active
polyarticular juvenile idiopathic arthritis (JIA) in children ages 2 years and older.

Psoriatic Arthritis

ENBREL is indicated for reducing signs and symptoms, keeping joint damage from getting
worse, and improving physical function in patients with psoriatic arthritis. ENBREL can be
used with or without methotrexate.

Ankylosing Spondylitis(AS)

ENBREL is indicated for reducing signs and symptoms in patients with active ankylosing
spondylitis.

Moderate to Severe Plaque Psoriasis

ENBREL is indicated for the treatment of adult patients (18 years or older) with chronic
moderate to severe plaque psoriasis who are candidates for systemic therapy or
phototherapy.



At Enbrel.com, you can learn about Enbrel® (etanercept), a self-injected biologic medicine
used to treat inflammatory diseases with long-term effects. You can find information about
moderate to severe rheumatoid arthritis(RA), moderate to severe plaque psoriasis, psoriatic
arthritis, moderately to severely active polyarticular juvenile idiopathic arthritis(JIA), and
ankylosing spondylitis(AS). You can learn about symptoms, treatment, how Enbrel®
(etanercept) works for each condition, results for each condition, results for each condition, and safety information.

Enbrel.com supports you and your loved ones from diagnosis to treatment. You can find
resources like injection demonstrations, patient testimonial videos, questions to ask your
doctor, and even help with finding a rheumatologist or dermatologist near you.

Enbrel.com also provices ongoing assistance with ENBREL SupportTM, a patient support
program to help with out-of-pocket costs and connect you with registered nurses and
ENBREL Nurse Partners. The resources available will help you get started. Resources
include the ENBREL Starter Kit, injection and medicine refill reminders, free needle disposal
containers, travel packs, and ongoing education.

  • See More
  • See More
IMPORTANT SAFETY INFORMATION:
What is the most important information I should know about Enbrel® (etanercept)?

ENBREL is a medicine that affects your immune system. ENBREL can lower the ability of your immune system to fight infections. Serious infections have happened in patients taking ENBREL. These infections include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections. Your doctor should test you for TB before you take ENBREL and monitor you closely for TB before, during, and after ENBREL treatment, even if you have tested negative for TB.