Remicade Charges

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ediekristen
Veteran Member


Date Joined Apr 2007
Total Posts : 1366
   Posted 1/8/2009 12:28 PM (GMT -6)   
Well, my three month waiting period on Imuran is up and I've gotten nothing but worse. At my last appointment, my doctor said if I wasn't better by the next one (1/12/09) that we would be moving on to Remicade.

I called my insurance company but they were very helpful and basically said "We can't say until the charge actually comes in" so I was wondering, those of you on Remicade, how is this charged? I have medical insurance plus a separate insurance that pays for medication... Do you pay a copay for the medication and then charges for an infusion center? What other costs go along with it?? I'm a little concerned that it might be too pricey but I know I only have a $20/$40 copay for the medication so that's a plus. I just don't want to get my hopes up and then get my first infusion and find out there's no way I can afford it   sad


Female, 23, Ulcerative colitis (pancolitis) since 1999; GERD; gastritis; osteopenia in femur head & lumbar spine from long term prednisone use...

Current Meds:
Lexapro 10mg, Azasan 100mg

 
 


vega19
Regular Member


Date Joined Sep 2008
Total Posts : 91
   Posted 1/8/2009 1:37 PM (GMT -6)   
I was shocked when I got the EOB from my insurance company showing how much they were billed for my 1st infusion. I am at 10mg/kg which is the high dose. I called the hospital to get a detailed bill to make sure they weren't over billing or something. I'm 135 lbs which converts to just over 60 kgs. The cost of the remicade alone (not counting the IV, premeds, etc...) was about $15000. The total bill was over $17000. I have a seperate carrier for my prescriptions as well but this goes thru my medical. I don't pay a copay when I go the hospital infusion center. I have a $2000.00 out of pocket max with my insurance so for the initial infusion I had to pay about $1000.00 which I was able to make payments on. I haven't had to pay for any other infusions because I met my max so they were covered in full! Of course, it is a new year so I'm back at $0 for my out of pocket so I will have to pay some of my next infusion.
31 year old female diagnosed with UC (entire colon) Feb 2008
(4) 400mg Asacol 3x a day
Remicade 10mg/kg every 8 weeks
Omega 3 supp, calcium supp, VSL 3
Prednisone 5mg - almost done!!! YAY!


Meesh
Veteran Member


Date Joined May 2006
Total Posts : 619
   Posted 1/8/2009 2:55 PM (GMT -6)   
Mine isn't quite that costly, and I don't pay any copays for hospital procedures like Remicade infusions, but I did accidentally get billed once and it's $6,000 a pop (every six weeks), standard dose. My GI's office sorted out the insurance coverage prior to my first infusion.

If the GI office doesn't get anywhere you should try your HR director if you have insurance through work. Dealing with that **** is part of their job description. Don't start infusions until you get it sorted out; typical protocol calls for several infusions in quick succession -- first one followed by another in 2 weeks, then another in 4 weeks after that. By the time the paperwork gets submitted you may have had your first three infusions and be on the hook for quite a lot of money. Also, once you start you don't want to have to stop because you may not be able to get back on again, apparently antibodies can develop. So you definitely want to get that all sorted out prior to the first infusions.

Good luck though, when it works it REALLY can be a godsend and give you back a normal life. All I have now are the occasional rough mornings, typically when it gets close to infusion time.

Meesh
46 yr old female, dx'd UC April 27, 2006; mild arthritis in lower back, dx'd May 2008; Osteopenia dx'd 6/08 Finally achieved remission mid October 2008!!
12 Remicade infusions: 7/21/07; 8/18/07; 10/13/07; 12/15/97; 1/26/08; 3/8/08; 4/19/08; 5/24/08; 7/5/08; 8/15/08, 9/26/08; 11/08/08; 12/20/98; Current meds & supplements: Lialda, 4 tabs in the morning; Xanax as needed (rarely); Rowesa and/or Canasa; multivitamin w/folate; Culturelle; Fish oil capsules, calcium chews and/or Tums; Vitamin D; Past meds: Prednisone 4/06-4/08; Entocourt EC; Asacol; Colazal; Venofer (iron) injections Dec '07; Imuran (extremely bad reaction 2/07); Protonix; Lexipro


jujub
Elite Member


Date Joined Mar 2003
Total Posts : 10407
   Posted 1/8/2009 4:59 PM (GMT -6)   
It depends on the setup. When I lived in Texas, my GI's practice had their own infusion facility. Since it was billed from the GI practice, the insurance considered it an office visit and I paid only my $35 copay. Where I live now, the practice uses the hospital infusion facility, so it's billed as hospital treatment and I pay my 10% portion. So it's gone from costing me a bit over $200 a year to maxing out my out-of-pocket expenses at $1500 for the first two infusions.

I plan to be sure I have my knee surgery and anything else I need this year, since it will be free. Then I may look around to see if there are any GI's in this area who have their own infusion centers.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Avascular necrosis in both shoulders is my "forever" gift from Entocort.
Colazal,  Remicade, Nature's Way Primadophilus Reuteri. In remission since April, 2006.
"My life is an ongoing medical adventure"
 
Co-Moderator UC Forum
Please remember to consult your health care provider when making health-related decisions.


bookworm21
Veteran Member


Date Joined Mar 2008
Total Posts : 1766
   Posted 1/8/2009 4:59 PM (GMT -6)   

If you do have a co-pay, you'll probably be eligible for RemiStart. It's provided by the makers of Remicade and they cover co-pays. Try calling the finance/billing people at the hospital or your doctor's office and see if they can help you figure out the cost.

I know last summer we were talking about surgery a lot. I'm assuming that you're willing to go on Remi long-term before thinking surgery again?


Female, Age 20
9 Asacol, Rowasa1000 mg Canasa, Proctofoam, Rifaximin 2/day
Digestive Advantage (Crohn's & Colitis)1 Florastor, 50 mg 6MP,1 Primadophilus reuteri, Remicade (5 infusions), 2.4 g Lialda, Forvia, 6 Colazal, 1 Anucort, Culturelle, Fish Oil, Calcium/Vit D supplement, 10 mg Prozac, VSL #3
 


neednewbody
Regular Member


Date Joined Sep 2008
Total Posts : 59
   Posted 1/8/2009 5:16 PM (GMT -6)   

in canada - my remicade was about $3000.00 per infusion and the drug and infusion nurses, etc was all included in the cost.  my drug plan covers 100% (I pay extra for that - totally worth it)

 

for the person who called her insurance company, you should be able to give them the DIN - drug identification number and they should be able to check to see if it is covered for you.  And, if you call the remicade co-ordinator (I assume you have a person/nursing company in charge) they can tel you the rest of the billing process/

 


Liver transplant 2004 -- liver is only healthy part of me
Prograf 1mg bid for transplant
 
Remicade every 6 weeks - not working
pentasa 1500mg tid
palafer once daily
lomotil every day as needed
immodium every day as needed
 


Eva Lou
Veteran Member


Date Joined Sep 2006
Total Posts : 3442
   Posted 1/8/2009 5:41 PM (GMT -6)   
totally depends on how it's billed- I go to a hospital to get my infusions, & they bill it as "chemo". My current insurer (Harvard Pilgrim) covers all chemo in full. However, they consider Remicade administration to be out-patient surgery, as it's an invasive procedure. Which would be a $250 co-pay per infusion! But since the hospital bills as chemo, it's covered in full for me- thankfully! My last insurer (Blue Cross/Blue Shield) did not cover Remicade under their prescription plan- since it's not self-administered & needs to be administered by a trained professional. So, under that plan, it was considered part of my medical benefit, and it was also covered in full (I've been lucky). The quickest way to find out what you will pay, if any, is to call your insurer & tell them you are going to be starting Remicade & ask them how they cover it under your plan. I've done that with both my most recent insurers & they've been pretty helpful. You'd definitely want to find out how it's covered so you don't get stuck with a big bill. I'm just hoping my current insurer doesn't catch on that my "chemo" treatments are really Remicade infusions, & sock me with a gigantic bill! then if you freak out with what your insurer tells you, call the infusion center & ask them how exactly they bill it, as a procedure, a med, etc. Good luck!

diagnosed with UC '02
meds-
Asacol- 8 tabs/day
Remicade-10mgs/kg- since 4/07
Imuran- 150mgs/day
Culturelle
Fiber supplement
 
 
 


ediekristen
Veteran Member


Date Joined Apr 2007
Total Posts : 1366
   Posted 1/12/2009 3:08 PM (GMT -6)   
Thanks for the replies, everyone. I went for my appointment today and my doc has finally decided to start me on Remicade. My most recent labs showed everything all sorts of messed up- high WBC, low RBC, low liver results, anemia, etc. So he says the logical thing to do here is start on Remicade and if it doesn't work for me then he's going to refer me to a specialist, and maybe even start talking surgery. I had been thinking a lot about surgery through last year, but (to answer your question, ComedyDork) I did decide to try Remicade first. I'd say I'm almost comfortable with the idea of surgery, but I'm just not quite there yet. When I start really thinking about it I freak out a little. So, I'm just hoping this works but if not then I guess I'll go from there.

They weren't sure where I would be able to go for my infusions so the secretary told me she has to work on it a bit and if I don't hear by Friday then to call her back, so I'm not sure yet when I'll be going for my first infusion. But he dosed it where I'd get one infusion, then another in two weeks, and then one every six weeks. Just crossing my fingers now that it's not going to be crazy expensive.

Eva Lou
Veteran Member


Date Joined Sep 2006
Total Posts : 3442
   Posted 1/12/2009 4:38 PM (GMT -6)   
Good luck! I hope it works well for you- I'm surprised your GI is starting you at a 6 week dosing schedule- that's about as frequent as you can get. What did your insurer say about coverage? Were you able to get any answers?

diagnosed with UC '02
meds-
Asacol- 8 tabs/day
Remicade-10mgs/kg- since 4/07
Imuran- 150mgs/day
Culturelle
Fiber supplement
 
 
 


ediekristen
Veteran Member


Date Joined Apr 2007
Total Posts : 1366
   Posted 1/12/2009 4:52 PM (GMT -6)   
When I called, the insurance company wasn't helpful at all and the lady seemed to have no idea what she was talking about. I'm hoping that the doctor's office can get more information than I did and then relay it to me. I wish I didn't have to wait till Friday though because now I'm anxious!

Female, 23, Ulcerative colitis (pancolitis) since 1999; GERD; gastritis; osteopenia in femur head & lumbar spine from long term prednisone use...

Current Meds:
Lexapro 10mg, Azasan 100mg

 
 


Scrap Girl
Veteran Member


Date Joined Jan 2007
Total Posts : 653
   Posted 1/12/2009 11:11 PM (GMT -6)   
You might have just gotten a clueless person when you called. I would think they would give you some idea as to the costs. I get mine through Caremark and I have to go through their specialty division for the expensive stuff. The drug co-pay is now $25 and the hospital charges about $500 for the infusion. I pay 20 percent of that cost.

Diagnosed with UC in Feb. 2005
 
Colazal (9 a day)
Folic Acid
Biotin
Calcium
Remicade


ediekristen
Veteran Member


Date Joined Apr 2007
Total Posts : 1366
   Posted 1/23/2009 2:29 PM (GMT -6)   
Well, I FINALLY got a call back from my doctor. They told me to call the cancer infusion center where I will be going and speak with them. Not a great phone call...
Apparently, with them the Remicade costs $20,000. She said right now they are working with Centocor and my insurance to figure out the most reasonable way to charge it so I don't pay an outrageous amount (I was told by my insurance I'd have to pay 20%... That's $4,000 per infusion out of pocket!!!)

One plus: I have a $1500 out of pocket max, so most likely I would just get stuck with one $1,500 bill and that's it for the year.
But the infusion center lady told me she has a patient who works for the same hospital network and has my same insurance, and she has the Remicade shipped directly to their pharmacy and that it would be a lot cheaper, because the other girl used to pay $800 a month but now she pays a lot less (but the lady couldn't remember what it was). Sooooo it looks like I'll be making a lot of phone calls and dealing with a lot of aggravation before I can finally get this started. I was a little bit discouraged when I hung up the phone but I'm just hoping I can get something figured out. I'm also going to call the number for the RemiStart program and see what they say as well.

I guess wish me luck and hopefully I'll be starting my infusions within a week or two, because not being on meds is starting to catch up with me :(

Female, 23, Ulcerative colitis (pancolitis) since 1999; GERD; gastritis; osteopenia in femur head & lumbar spine from long term prednisone use...

Current Meds:
Lexapro 10mg, Azasan 100mg

 
 


Scrap Girl
Veteran Member


Date Joined Jan 2007
Total Posts : 653
   Posted 1/23/2009 2:40 PM (GMT -6)   
That sounds on the high side to me. I don't know exactly how much mine would be without insurance but I know it was less than $10,000. You might see if there is anywhere else you can go for the infusions. I remember you can find a list of all of the places authorized to infuse Remicade through Centacor's website. In 2009, the key word is "negotiate" and everything is negotiable - not just cells phone plans and cable bills. I have my Remicade shipped through Caremark and it is much cheaper ($25) than it would be if I had to order it at the hospital where my infusions are given. Good luck!

Diagnosed with UC in Feb. 2005
 
Colazal (9 a day)
Folic Acid
Biotin
Calcium
Remicade


Christine1946
Veteran Member


Date Joined Aug 2008
Total Posts : 5968
   Posted 1/23/2009 3:10 PM (GMT -6)   
     Wow, no wonder the drug company sends the doctors who push Remicade on cruises.

62 yr old granny. South Jersey
Diagnosed with ulcerative proctitis in 1998 in hospital
Hospitalized (2nd time) in May 2008
Update 11/03/08...finally in remission!!  Hope I don't jinx myself.  Off the prednisone since 11/01/08...now see if I can stay off for longer than two weeks.  Other meds: 6MP (75 mgm), colazal (6 per day), Benicar and Toprol (high blood pressure meds), Probiotic (2 per day), fish oil capsule and multi-vitamin and calcium with vitamin D.


ediekristen
Veteran Member


Date Joined Apr 2007
Total Posts : 1366
   Posted 1/23/2009 3:22 PM (GMT -6)   
Yeah, seriously! The patients should get to go on cruises for bringing in the money and [possibly] paying the outrageous out of pocket costs.

Female, 23, Ulcerative colitis (pancolitis) since 1999; GERD; gastritis; osteopenia in femur head & lumbar spine from long term prednisone use...

Current Meds:
Lexapro 10mg, Azasan 100mg

 
 

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