When Remicade was the only biologic approved for Crohn's, and it was showing great promise in gving patients relief and possible remission, some GIs decided to
open their own infusion centers. Insurance companies reimbursed the practice for the medication cost less the patient's co-pay if any. Depending on the insurance plan, doctors agree by contract to accept specified reimbursement for the "delivery" of the medication. This usually includes the IV solution, personnel to oversee the patient for a set time limit, etc. The set reimbursement varies widely between insurance plans. Where my GI lost about
$100 on each of my infusions, his contract with another insurer might be more generous and net him enough to cover that deficit plus a little extra.
What is happening now is a couple of things. Remicade iis no longer the only biologic. Fewer patients are using Remicade. Private GI infusion centers are not as well utilized so the salaries of the personnel might not be covered by the fewer insurance reimbursements. Doctors will only continue to absorb such a loss for a short ime. In addition, the cost of biologics increases approximately 7-8% a year. Depending when the insurance contract was executed, the doctors might not recoup even the cost of the medication.
Just my $0.02.
Moderator Crohn's Disease Forum
CD, Ankylosing Spondylitis, lupus, small fiber peripheral neuropathy, avascular necrosis, peripheral artery disease, degenerative disc disease, and a host of other medical problems.