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Remicade and insurance

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Crohn's Disease
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Posted 9/5/2007 10:24 AM (GMT -6)
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!
Posted 9/5/2007 10:31 AM (GMT -6)
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!
Posted 9/5/2007 1:53 PM (GMT -6)
Same here. $0

The doctor's office should call ahead to the insurance company to get approval, but it shouldnt be a problem.
Posted 9/5/2007 1:57 PM (GMT -6)
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.

Rhonda

Posted 9/5/2007 3:46 PM (GMT -6)

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.

Posted 9/5/2007 5:03 PM (GMT -6)
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.
Posted 9/5/2007 6:31 PM (GMT -6)
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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