How Do You Pay For Your Remicade?

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OlderThanDirt
Regular Member


Date Joined Oct 2010
Total Posts : 192
   Posted 10/5/2011 8:35 PM (GMT -6)   
My GI is considering putting me on remicade.  I am on Medicare.  Since Remicade is given in a hospital, I am assuming my Medicare Part A or B will pay for most of it 80 percent.  That means I have to pick up the remainder?  I am on social security and that would be my enitre check. 
 
Am looking for someone who knows how this would work and can give me some pointers.  Thanks.

Endeavor08
Regular Member


Date Joined Dec 2010
Total Posts : 380
   Posted 10/5/2011 8:44 PM (GMT -6)   
Remicade has a financial assistance program, I think it is called Remistart.

Can't offer any advice on what you need to have to qualify and all those specifics, but best of luck!

clonehead
Veteran Member


Date Joined Jan 2011
Total Posts : 613
   Posted 10/5/2011 9:00 PM (GMT -6)   
I'm not sure how Medicare categorizes Remicade.

Would they qualify the Remicade itself as a drug, subject to Rx benefits, and the hospital related facility charges as Part A/B, or does the hwole thing become Part A/B?

Do you have a medicare supplement policy or a Part D plan?

According to the Remicade website, "Medicare carriers and the claims processors for all states cover infusions of REMICADEĀ® in doctors' offices and hospital outpatient facilities. The traditional Medicare Fee-for-Service Program does not cover infusions of REMICADEĀ® when they are provided by home infusion companies or retail pharmacies."

It doesn't go into details as to how it is categorized or how much is covered.
Crohn's Disease for 22 years
Diagnosed in Feb 1989 at age 14

1 Resection: 4" at terminal ileum + 24" of jejunum - June 2011
Current meds: Humira (since March 2011)
Also take: monthly B12 injection, Calcium, Multivitamin

clonehead
Veteran Member


Date Joined Jan 2011
Total Posts : 613
   Posted 10/5/2011 9:21 PM (GMT -6)   
A bit more searching, and it seems that it is covered as a Part B benefit, so yes, the Part B deductible and coinsurance would apply.

There is the remistart program mentioned above that you could look into to help with coinsurance.

Medicare Supplement insurance, if you have it.

Also, it seems that the price varies quite a bit by provider, whether they accept medicare, and whether they would send you to a large infusion center or for-profit hospital setting vs. having it done in a smaller setting or a not-for-profit hospital.
Crohn's Disease for 22 years
Diagnosed in Feb 1989 at age 14

1 Resection: 4" at terminal ileum + 24" of jejunum - June 2011
Current meds: Humira (since March 2011)
Also take: monthly B12 injection, Calcium, Multivitamin

OlderThanDirt
Regular Member


Date Joined Oct 2010
Total Posts : 192
   Posted 10/6/2011 8:04 AM (GMT -6)   
@ clonehead
Thanks sooooo much for looking into this. I feel better now, knowing that this isn't part of my prescription drug plan, but rather part B. I have Medicare and a medigap policy so I guess I need to look into my medigap policy and see what they will cover and then the medistart. Thanks again.
OlderThanDirt
Misdiagnosed 25 years w IBS. Crohn's dx 8/10.
Gallbladder out '97. Taking Lialda, 6MP, Prednisone, B12 shots, Vit. D, Prevacid
"Thank God for fellow crohnies. They know the words to the song in your heart when you've forgotten how they go."

clonehead
Veteran Member


Date Joined Jan 2011
Total Posts : 613
   Posted 10/7/2011 9:02 PM (GMT -6)   
You're welcome. Yes, your coverage could vary depending on which medigap plan letter you have, but I believe they all cover the 20% part B coinsurance. Some plans also cover the deductible. Your policy and/or insurance company should be able to confirm those details.

And you should verify with the hospital or infusion center beforehand that they accept Medicare.
Crohn's Disease for 22 years
Diagnosed in Feb 1989 at age 14

1 Resection: 4" at terminal ileum + 24" of jejunum - June 2011
Current meds: Humira (since March 2011)
Also take: monthly B12 injection, Calcium, Multivitamin

ep49
Regular Member


Date Joined Apr 2010
Total Posts : 170
   Posted 10/7/2011 11:37 PM (GMT -6)   
You can also go to the Remicade website for information on the patient assistance program. You then can download forms to fill out and send back. They will make a decision and let you know if you are eligible for assistance with the cost of treatment. I did it myself for help with the cost of Humira and am now waiting for a reply. My doctor said that the companies are very generous for those who do not have any insurance at all or inadequate insurance to cover the costs.
Diagnosed 8/2009 with proctitis and left sided UC
Diagnosis now changed to Crohn's disease
Lialda, 3 pills once a day but switching to biologics soon
Suffer from rectal stricture which was dilated 6/11
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