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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 9 digit RxID 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 9 digit RxID card number here:

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Still having problems?

Get a new card

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

In addition to the below consent, I understand that by checking this box and by checking “I accept” [below], I consent to Amgen calling and texting me at the phone number(s) I have provided with promotional communications relating to Amgen products and services and/or my condition or treatment. Amgen may use automatic dialing machines or artificial or prerecorded messages to contact me and may leave a voicemail or SMS/text message (standard text messaging rates may apply). I understand that I am not required to provide this consent as a condition of purchasing any goods or services.

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

Amgen’s Privacy Pledge to Patients

Amgen respects patients and customers and takes the protection of their privacy very seriously. Amgen pledges the following:

  • Amgen does not and will not sell or rent your information to marketing companies or mailing list brokers.
  • Amgen is careful to only collect and/or use personal identifiable information for the purposes stated in this Authorization and as necessary to provide the services and/or programs the patient or customer chooses to enroll into.
  • Amgen practices are consistent with federal and state privacy laws, including HIPAA.
  • Amgen program enrollment is voluntary and always provides patients with an easy option to cancel participation.

Amgen’s Privacy Notice and Patient Authorization

Uses and Disclosure of Personal Information

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

  • To operate, administer, enroll me in, and/or continue my participation in Amgen’s ENBREL Support™ program or any other Amgen-affiliated patient support services and activities related to my condition or treatment (for example, co-pay card programs, reimbursement assistance programs, drug coverage verification, nurse educator services, adherence program and disease management support);
  • To contact, with my permission, my doctor and the rest of my health care team and share with them my health information that may be useful for my care;
  • To provide me with informational and promotional materials relating to Amgen products and services, and/or my condition or treatment; and/or
  • To improve, develop, and evaluate products, services, materials and programs related to my condition or treatment.

In order for Amgen to provide me with the services and/or programs described above, Amgen needs to collect and use my personal information, including my personal health information. I understand that my personal health information may include any information, in electronic or physical form, in the possession of or derived from a health care provider, health care plan, pharmacy, pharmaceutical company, laboratory and/or their contractor (“Health Care Provider”). This may include select information from or about my medical history and general health, my health care plan benefits, payment limits or restrictions covered by my health care plan policy, and/or my adherence to my treatment.

I authorize my Health Care Providers to disclose my personal health information to Amgen, and between themselves, as necessary, but only for the purposes stated above in this Authorization. I understand that certain of my Health Care Providers (such as pharmacies and specialty pharmacies) may receive remuneration from Amgen in exchange for disclosing my personal health information and/or for using my information to contact me with communications about Amgen products which have been prescribed to me (for ex. adherence programs) and other patient support services.

Expiration, Right to Obtain a Copy and Right to Cancel

I understand that by signing this form, I authorize my Health Care Providers or others who might hold my health information to only release it to Amgen employees, as well as to its contractors and business partners, who are performing the services set forth in this Authorization. I also understand I am authorizing my personal information, including my personal health information, to be used for the purposes described above. I understand and agree that by signing below, I am authorizing those who rely on this Authorization to release my personal health information for the earlier of five (5) years or until my participation in the program ends through my cancellation, unless a shorter time period is required by state law.

I understand that I can obtain a copy of this Authorization or cancel this Authorization at any time by calling Amgen at 1-888-4ENBREL (1-888-436-2735) or by writing to PO Box 7249, Bedminster, NJ 07921. If I cancel my consent, I will no longer qualify for the services described. I also understand that if a Health Care Provider is disclosing my personal health information to Amgen on an authorized on-going basis, my cancellation with Amgen will be effective with respect to any such Health Care Providers as soon as they receive notice of my cancellation.

No Effect on Treatment

I understand I do not have to sign this Authorization and that my enrollment in any of the services and/or programs described above is entirely voluntary. I understand that Amgen, as well as Health Care Providers, cannot require me, as a condition of having access to medications, prescription drugs, treatment or other care, to sign this Authorization. Federal Law (including HIPAA) requires a signed authorization in order for Amgen to collect this information from my Health Care Providers. I understand I cannot participate in the listed services and/or programs without signing this Authorization or an equivalent authorization with my Health Care Providers.

Information Received from Health Care Providers

I understand that once my personal health information has been disclosed to Amgen, federal privacy laws may no longer apply and protect it from further disclosure. Amgen agrees, however, to protect my personal health information by only using and disclosing it as stated in the Authorization or as otherwise allowed or required by law. I understand that Amgen does not and will not sell or rent my information to marketing companies or mailing list brokers.

Authorization to Contact

I understand and consent to Amgen contacting me using the contact information provided in this form to enroll me in, operate, and administer Amgen patient support services and/or programs as described above other than promotional communications by telephone or SMS/text (which I can separately opt-in when I provide my phone number). I understand that the operation and administration of certain of these services and/or programs may require that Amgen contact me by telephone or SMS/text.

By clicking the “I accept” button, you are electronically providing your consent and indicating your legal authorization for Amgen and its contractors and business partners to use and share the personal information you give only for the purposes described within the above authorization. You are also indicating that you are at least 18 years old by clicking the “I accept” button. By clicking “Cancel” below, you will discontinue activation and enrollment into the ENBREL Support™ program, and no further action will be taken.


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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 9 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 healthcare provider 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 may be more likely to get lymphoma.

Before starting ENBREL, tell your healthcare provider 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 healthcare provider 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 healthcare provider 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 healthcare provider
  • 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 and upper respiratory infections (sinus infections).

In general, side effects in children were similar in frequency and type as those seen in adult patients. The types 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 healthcare provider 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 healthcare provider. 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 chronic moderate to severe plaque psoriasis (PsO) in children 4 years and older and adults who may benefit from taking injections or pills (systemic therapy) or phototherapy (ultraviolet light).

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 healthcare provider 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 may be more likely to get lymphoma.

Before starting ENBREL, tell your healthcare provider 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 and upper respiratory infections (sinus infections).

In general, side effects in children were similar in frequency and type as those seen in adult patients. The types 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 healthcare provider 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 healthcare provider. 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 chronic moderate to severe plaque psoriasis (PsO) in children 4 years and older and adults who may benefit from taking injections or pills (systemic therapy) or phototherapy (ultraviolet light).

  • 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 healthcare provider 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 may be more likely to get lymphoma.

Before starting ENBREL, tell your healthcare provider 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 general, side effects in children were similar in frequency and type as those seen in adult patients. The types 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 healthcare provider 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 healthcare provider.
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 chronic moderate to severe plaque psoriasis (PsO) in children 4 years and older and adults ages who may benefit from taking injections or pills (systemic therapy) or phototherapy (ultraviolet light).



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 healthcare provider 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.