Remicade and insurance

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Regular Member

Date Joined Aug 2007
Total Posts : 89
   Posted 9/5/2007 9:24 AM (GMT -7)   
My doc wants to talk about starting Remicade. I have not done any other meds except trying Entocort and Prednisone and I had a reaction to both where my breathing was compromised. I also have asthma so I was pulled off those right away. Do I understand that your insurance company has to sign off on Remicade before you can use it? Also, if anyone is comfortable discussing it, how much do you end up having to pay for the treatments? I have Federal Blue Cross/Blue Shield. If you prefer not to discuss dollar amounts, can you give me a general idea of coverages you've experienced? Thanks!
Dx'd CD in August 2007
Allergic to Entocort and Prednisone / Not sure what's next
Currently on Protonix

Veteran Member

Date Joined Mar 2006
Total Posts : 501
   Posted 9/5/2007 9:31 AM (GMT -7)   
Well I used to have a PPO through Blue Cross, it was a 60/40 plan.  My copay for Remi was $5,000 per infusion which is every 2-3 weeks in the beginning. I had to quit my job and find a BIG company that had better benefits and now I am on a cheap HMO!  I have $0.00 copay and was able to start Remicade.  It has to be authorized before you can start. The remicade person in your doctor's office should be able to get the authorization and tell you your copay amount, and if it's an HMO, it should not be more than $50, if I understand correctly.  Good luck!
Diagnosed 1/06
CD of Terminal Ileum
Taking Pentasa, Entocort, Prograf and Remicade.

Regular Member

Date Joined Apr 2007
Total Posts : 345
   Posted 9/5/2007 12:53 PM (GMT -7)   
Same here. $0

The doctor's office should call ahead to the insurance company to get approval, but it shouldnt be a problem.
32 years old. Diagnosed in 2002ish. 
Taking Asacol, Lomotil TID, and on Remicade since 2004. 
Lower Bowel area only, except for the short stint (about 2 weeks) that I had mouth sores.  Also have external/anal fistula and anal/vaginal fistula. 

Regular Member

Date Joined Jan 2006
Total Posts : 47
   Posted 9/5/2007 12:57 PM (GMT -7)   
I work at Indiana University and have a specialty pharmacy I order my Remicade through. My prescription costs are $40 for a 30 day supply so I pay $80 every 8 weeks for Remicade and $20 co-pay for the administration of it. My doctor's office has a person that deals with it and the insurance approval. It took a good couple of weeks to get it approved.

Regular Member

Date Joined Feb 2007
Total Posts : 33
   Posted 9/5/2007 2:46 PM (GMT -7)   
I will be starting Remicade on Sept. 21st, had my TB test done today.
My insurer is United Health Care, and they cover it 100%.
It will be done in an infusion center.
Took about a month for United Health Care to authorize the Remicade.

Veteran Member

Date Joined Apr 2006
Total Posts : 686
   Posted 9/5/2007 4:03 PM (GMT -7)   
I have Oxford and just pay a $15 co-pay to have the Remicade infusion done in my drs. office. With my policy I do not need any pre cert to receive remicade in a doctors office, however if the infusion is done some where else I need the pre cert.

Remicade and 6MP

Regular Member

Date Joined Aug 2006
Total Posts : 196
   Posted 9/5/2007 5:31 PM (GMT -7)   
I have Federal Aetna Insurance. There was a pre-approval involved. My co-pay $25.00 for infusion at a hospital. I've also had every test you can imagine, plus 2 surgeries - 1 bowel resection and 1 hernia op. All in about 2.5 years. The Federal Insurance program has been good to me. Not sure how BC/BS will treat you - good luck.
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