cost of remicade

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

ktownharry
New Member


Date Joined Mar 2008
Total Posts : 19
   Posted 4/8/2008 9:38 AM (GMT -6)   
mad  I just found out my united health care insurance does not cover remicade. Does anybody know anything about the cost i'm about to inherit? April 14th I get another scope which my body is telling me I will fail so the next and last choice is remicade. This was determined by my dr. since i've pretty much exhausted my other options. I'm hoping to delay the start of remicade until July when i can establish a new FSA withdrawal plan. Any help will be greatly appreciated. Just found this site accidentally somehow last month. Thank God!!!! Just got computer 1 year ago. Thank God for the internet!!!!  Suffering 21 years with ulcerative colitis induced by ibuprophene taken for joint pain 1988. After 1 week of ibu I was bleeding and still am!!!

GardenerJames
Veteran Member


Date Joined Jan 2006
Total Posts : 616
   Posted 4/8/2008 9:49 AM (GMT -6)   
Hi Harry, sorry you're having to go through this! Remicade can run between 2,000 and 8,000 dollars depending on where you get it. The higher prices can probably be negotiated down a bit if you pay up front or something.
If you can handle it, there's probably no reason you can't wait until July to start it. The next 3 months just won't be very fun :(
Good Luck!
James
Asacol 4 tabs 2x daily www.myspace.com/gardenerjames
Forvia once a day
Probiotic twice daily
Methotrexate 3 pills once a week
Actonel once a week
Calcium supp.
1 mg Folic Acid daily
Omega-3 once daily
12th Remicade infusion End of March


ktownharry
New Member


Date Joined Mar 2008
Total Posts : 19
   Posted 4/8/2008 10:11 AM (GMT -6)   
Thank you Gardenerjames!! I knew it wasn't going to be cheap. I noticed your on your 12th. Does your insurance cover it? I'm still in a the shock stage cause i only found out about my insurance situation a half hour ago via their website and confirmed by my hospital billing agent our friend since we talk to each other so much fighting billings. I suppose i can wait til monday and ask my dr. but do you have any idea about the determination of remicade amounts and or # of infusions?

kb5
Veteran Member


Date Joined Jan 2007
Total Posts : 1015
   Posted 4/8/2008 10:20 AM (GMT -6)   
I'm going for my third today. Mine costs 9,800.00 each time. But i am a big girls and it goes by weight. Can your doctor petition for you? my GI had to prove that we had tried everything else before my insurance would budge. Also you have a better chance if they keep asking. Many times the insurance company won't give until you ask three or more times.

Good Luck
Kelly, 30

Left sided UC diagnosed 1/98 age 19, Pan colitis diagnosed 1/07
Currently on 4x3 Asacol, 5mg pred, 150mg Imuran
Prontonix once daily for acid reflux, zofran twice daily for nausea, darvocet for pain
antispasmodics didn't work.


GardenerJames
Veteran Member


Date Joined Jan 2006
Total Posts : 616
   Posted 4/8/2008 10:26 AM (GMT -6)   
I have received Remicade via 3 different insurance companies. All of them paid 80% until I had reached my yearly maximum out of pocket (between 1,000 and $2,500). I would have your GI look into preauthorization. That's usually what you need to get your Remicade covered. Don't count on what you read on their website, I'm pretty sure it's meant to make you think they won't pay for anything.
I now have insurance through the Washington State Health Insurance Pool, which provides coverage for individuals who have been denied coverage by a provider. it's a little expensive but the coverage is GREAT. I am allowed 8 infusions per year by my insurance (I only need 6)
When I get my Remicade at my GIs office it is billed at $5,000 and insurance negotiates it down to about $3,000. When i have it at the hospital (due to some scheduling conflict at the GIs or whatever) they bill at $8,000 and insurance negotiates it down to 4 or 5,000. There was a thread on the bulletin board here sometime in the last week about the makers of Remicade helping to pay for your first year of treatments. I would try to find that post cause there was good information about that.
James
Asacol 4 tabs 2x daily www.myspace.com/gardenerjames
Forvia once a day - Probiotic twice daily - Methotrexate 3 pills once a week - Actonel once a week
Calcium supp. - 1 mg Folic Acid daily - Omega-3 once daily
13th Remicade infusion End of April


GardenerJames
Veteran Member


Date Joined Jan 2006
Total Posts : 616
   Posted 4/8/2008 10:33 AM (GMT -6)   
Here's the address for that post apparently it's called the RemiStart program
http://www.healingwell.com/community/default.aspx?f=38&m=893255
Asacol 4 tabs 2x daily www.myspace.com/gardenerjames
Forvia once a day - Probiotic twice daily - Methotrexate 3 pills once a week - Actonel once a week
Calcium supp. - 1 mg Folic Acid daily - Omega-3 once daily
13th Remicade infusion End of April


disco
Regular Member


Date Joined Jan 2008
Total Posts : 154
   Posted 4/8/2008 11:21 AM (GMT -6)   
I just got OK'd for the Remistart program, but its a short term solution. If only covers you for a year than you SOL
Diagnosed in spring 2005 at age 28
Currently on 12 asacol pills a day + Entocort
40 MG Pred cycle stating 3/26


ktownharry
New Member


Date Joined Mar 2008
Total Posts : 19
   Posted 4/8/2008 1:06 PM (GMT -6)   
A BIG THANK YOU TO JAMES, KELLY, AND DISCO. I just got back from a workout, had to escape this anxiety rush, so this reply is late. I plan on printing out as much info or comments as needed so I'm armed and ready when the showdown occurs. Everyone can be asured that my anxiety level has been dropping every comment I read (my colon thanks you ha ha!). There is plenty of work still to do but thanks again for leading me in the right direction. Who known's I might be able to talk my dr. into my 4th 4 month cycle of predisone!

jujub
Elite Member


Date Joined Mar 2003
Total Posts : 10407
   Posted 4/8/2008 5:41 PM (GMT -6)   
Be sure your doctor has appealed the insurance company's decision. Then call customer service yourself and ask why, what clause in your policy excludes it. I have UHC also, but probably the policy coverages are different. What I have found is that they have a tendency to deny things that are expensive, but sometimes if you appeal and ask for explanations, etc, it helps. The cost of Remi private pay is just prohibitive. Mine is over $8000 including all of the charges.

I hope you can find a way to get this covered. Not many of us could afford $30 - 50K a year for treatment.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Asacol, Rowasa, Pentasa, Prednisone, Entocort, Azathioprine
Colazal,  Remicade, Nature's Way Primadophilus Reuteri. In remission since April, 2006.
 
Co-Moderator UC Forum
The information I share on this forum is based only on my own experience and study. It is important to consult your health care provider when making health-related decisions.


disco
Regular Member


Date Joined Jan 2008
Total Posts : 154
   Posted 4/8/2008 7:17 PM (GMT -6)   
my concern still remains about next year though.

I can up my coverage at work but it could still end up costing me several thousand of dollars a year,

what if it doesn't work?
Diagnosed in spring 2005 at age 28
Currently on 12 asacol pills a day + Entocort
40 MG Pred cycle stating 3/26


RGB
New Member


Date Joined Apr 2008
Total Posts : 1
   Posted 4/9/2008 1:40 AM (GMT -6)   
Newby here.
 
Its a shame that remicade is so expensive in the US.
I am a canadian living in england and all medication administered in hospitals here is free on the NHS.  I have now had 5 remicade infusions and not paid a penny. Im not gloating, its just shocking how expensive it is for you.
 
On the down side, I havent seen the light of remission for the entirety of the three years I have been diagnosed, though I have managed to get my weight back up to 180lbs by going to the gym.  It seems the only way for me to keep weight on is to work out hard.

disco
Regular Member


Date Joined Jan 2008
Total Posts : 154
   Posted 4/9/2008 8:27 AM (GMT -6)   
Its a disparity in insurance plan, I'm going ot have to pay 20% per infusion until I reach my yearly out of pocket max. of $1500
than after than it's free for me until next year when I have to pay out again
Diagnosed in spring 2005 at age 28
Currently on 12 asacol pills a day + Entocort
40 MG Pred cycle stating 3/26


kb5
Veteran Member


Date Joined Jan 2007
Total Posts : 1015
   Posted 4/9/2008 8:32 AM (GMT -6)   
Mine inusrance is the same way but my out of pocket is 10000. One infusion takes care of my year. I"m planning of taking full advantage. I'm going to see every doctor I can! I even have a EGD scheduled cause it's been 18 years since my GERD dx.
Kelly, 30

Left sided UC diagnosed 1/98 age 19, Pan colitis diagnosed 1/07
Currently on 4x3 Asacol, 5mg pred, 150mg Imuran
Prontonix once daily for acid reflux, zofran twice daily for nausea, darvocet for pain
antispasmodics didn't work.


jujub
Elite Member


Date Joined Mar 2003
Total Posts : 10407
   Posted 4/9/2008 8:41 AM (GMT -6)   
I think with my coverage it depends on where I get the infusion, too. If it's done at a hospital, then I'd pay 10% until I reached my out of pocket max. Because I go to my doc's infusion center, it's considered treatment in the office and I just pay the $35 copay for a specialist visit.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Asacol, Rowasa, Pentasa, Prednisone, Entocort, Azathioprine
Colazal,  Remicade, Nature's Way Primadophilus Reuteri. In remission since April, 2006.
 
Co-Moderator UC Forum
The information I share on this forum is based only on my own experience and study. It is important to consult your health care provider when making health-related decisions.


TraciZ
Regular Member


Date Joined Aug 2007
Total Posts : 255
   Posted 4/9/2008 9:08 AM (GMT -6)   

I totally agree with Judilyn. She said, "Be sure your doctor has appealed the insurance company's decision. Then call customer service yourself and ask why, what clause in your policy excludes it."

If your insurance has denied the treatment, talk to your doctor (more than once if necessary) and contact the insurance company. If the treatment is medically necessary and you have insurance, then they should help pay for it. I have independent health and they wouldn't cover one of my prescriptions until I called the doctor 2-3 times and they explained that it was a medically necessary treatment. Good luck!


disco
Regular Member


Date Joined Jan 2008
Total Posts : 154
   Posted 4/9/2008 9:36 AM (GMT -6)   
kb5 said...
Mine inusrance is the same way but my out of pocket is 10000. One infusion takes care of my year. I"m planning of taking full advantage. I'm going to see every doctor I can! I even have a EGD scheduled cause it's been 18 years since my GERD dx.

Once you reach your out of pocket max do you have to pay ANYTHING at all the rest of the year?
Co-pays for office visits or on otherp prescriptions?
Diagnosed in spring 2005 at age 28
Currently on 12 asacol pills a day + Entocort
40 MG Pred cycle stating 3/26


kb5
Veteran Member


Date Joined Jan 2007
Total Posts : 1015
   Posted 4/9/2008 9:54 AM (GMT -6)   
No. Nothing. I don't have copays. Once i reach 5000 we pay 20% til we reach 10000, then nothing. It sucks and yet is good. It's bad when I am in remission and have to pay almost 800 a month for my prescriptions but the years where ther is a colonoscopy thrown in and it's not so bad. Add an infusion and i'm visiting every doctor i can find. But seeing as how the 10,000 is a fourth of our income....not good. this plan also costs about 5000 a year in premiums (and that's just for me, my husband is compd by his work). Thank God I have parents that can help. I hate asking them but they love me and have the cushion to be able to help. Someday I will write a book, make millions, and buy them everything they could want.
Kelly, 30

Left sided UC diagnosed 1/98 age 19, Pan colitis diagnosed 1/07
Currently on 4x3 Asacol, 5mg pred, 150mg Imuran
Prontonix once daily for acid reflux, zofran twice daily for nausea, darvocet for pain
antispasmodics didn't work.


disco
Regular Member


Date Joined Jan 2008
Total Posts : 154
   Posted 4/9/2008 10:13 AM (GMT -6)   
that's pretty rough I thought mine was high at 1500
Diagnosed in spring 2005 at age 28
Currently on 12 asacol pills a day + Entocort
40 MG Pred cycle stating 3/26


UC since'76
Regular Member


Date Joined Dec 2006
Total Posts : 77
   Posted 4/9/2008 11:29 AM (GMT -6)   
Gardener James

Is there any way I can e-mail or private message you? (you will have to tell me how to private message, but I know about e-mail). I am dependant on my son. He needs to be able to move to Washington state for his work but my health insurance problems have kept him from moving ahead. We have heard about the high risk pool, but there is another thing for even lower income, under $1700 a month, Basic Health or something. We have been trying to find out about it. On the internet it seems too good to be true. I am trying to find out what the catch is. Maybe it is being poor enough to qualify for it! I am eligible for it.
Ulcerative Colitis since about 1976
Pan colitis since at least 1994
 
Never had a flare until MD gave massive dose of Magnesiun while hospitalized for bronchitis.
 
During subsequent hospitalization for the flare, GI looked me straight in the eye and said "don't ever stop using Asacol."
Insurance company thought otherwise so I'm on no meds.


princesscolon
Veteran Member


Date Joined Apr 2006
Total Posts : 733
   Posted 4/9/2008 1:09 PM (GMT -6)   
Ktownharry,
I just saw your post right now. I have the same insurance and they approved Remicade for me. I had already been taking it with my past insurance and it was a hassle to get it approved, but I was authorized to take it and if I remember right, my co-pay was $20.
Diagnosed with Left-sided UC in 1995 at age 15, Prednisone, Rowasa & Hydrocort. Enemas, Proctofoam, Sulfasalazine, Asacol, Probiotics, Fish Oil, Aloe Juice, Canasa, Enotcort, Colazol, Anamantle, Remicade, etc... had 1 inch deep rectal ulcer 2004, put on Remicade, August 2007:Increased Remicade dosage-700mg every 6 weeks,diagnosed w/ Psoriatic Arthritis & Fibromyalgia Current meds: Clorazepate, Lomotil,  Tylenol pm, Lyrica started 1/17/08, Flagyl 750 mgs started 4/2/08, Humira started 4/4/08


atom12
New Member


Date Joined Nov 2008
Total Posts : 1
   Posted 11/23/2008 5:36 PM (GMT -6)   
ktownharry -- I have been on Remicade for years now (at least 3, maybe more, I can't remember when I started). At first they were about 5,000 - 6,000 a pop. Now they are over 10K! Its outrageous to think that even an extremely wealthy person would have no problems paying this. Your situation is a bit different than mine, however, but I think you will nevertheless benefit from this info.

There is a program, funded by the government (through tobacco taxes, believe it or not) called the "Major Risk Medical Insurance Program" http://www.mrmib.ca.gov/mrmib/MRMIP.shtml . It is specifically for people who have been denied health insurance due to a pre-existing condition. Once you "graduate", insurance companies must accept you at a price no more than a 10% higher from the MrMIP fee. I'm not sure how it works for people who have insurance, and have been denied particular coverage -- that you'll have to look into -- I would think it would relate to a Dr's pre-authorization. Its not cheap, I pay around $500 a month, but the alternative is simply not an option.

Its been a blessing for me, as I have not had to be roped to a job in order to keep health insurance. Anyway, as screwy as our country is, I would not want to have Crohn's Disease in too many other places.

atom

Post Edited (atom12) : 11/23/2008 3:39:49 PM (GMT-7)


Probiotic
Veteran Member


Date Joined Mar 2007
Total Posts : 2832
   Posted 11/23/2008 9:18 PM (GMT -6)   
Mine is 100% covered by Aetna after my max out of pocket $1500 (including other non-remi expenses on my non-covered stuff). I am looking into the remistart program to cover the out of pocket for 09. Ihavenlt seen what insurance is paying yet but I'm sure its a whopper.
Pancolitis 20 years ago, full med-free remission 10 years,
Flaring/simmering on and off ever since, allergic to all 5ASAs
10 20 17.5 15 12.5 10 mg 8 7.5 20 17.5 mg pred, 100 mg Imuran
TCM, Probiotics (Primal Defense and others), DMSO, TSO, hookworm
Turmeric/circuminboswellia, fish oil, many vits/minerals
Lower-carb version of Specific Carb Diet (SCD), Remicade newbie
 
 
 


DeniseW
Regular Member


Date Joined Nov 2005
Total Posts : 346
   Posted 11/23/2008 10:41 PM (GMT -6)   
I think the remistart program pays for all but $150 of it. And they sent me a thing to renew this year, so it sounds like you can use it more than one year. There was also another program that I didn't use and can't remember the name of. I got lucky with my ins and am SO thankful for it. It is so expensive.
So sorry you have to deal with this.
dx 4/05 with pancolitis UC after birth of my second child...
18 months of vit e enema and scd remission
Flare since 7/07...almost to surgery, now almost well through mostly natural stuff
Remicade every 7w or so 
Been there, tried that....
 
Pregnant for the last time, due 11/18/08
 

New Topic Post Reply Printable Version
Forum Information
Currently it is Thursday, September 20, 2018 1:22 PM (GMT -6)
There are a total of 3,005,155 posts in 329,200 threads.
View Active Threads


Who's Online
This forum has 161762 registered members. Please welcome our newest member, TruthSeekerSam.
356 Guest(s), 16 Registered Member(s) are currently online.  Details
SoMuchFun, notsosicklygirl, PeterDisAbelard., Michael_T, sebreg, Serenity Now, echymas, Anitas, Girlie, FamilyGuy, InTheShop, quincy, oregonhay, ltc1225, cppoly, (Seashell)