Remicade costs,,with and without insurance

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cra43
Regular Member


Date Joined May 2008
Total Posts : 172
   Posted 8/21/2009 10:15 AM (GMT -6)   
Ok,  I have some cost questions,,and this may get complicated.
First my  son has colitis , and a lot of you gave me great advice that I passed on to him.
He has NO health insurance because he cannot buy it due to his colitis.  He has his own little business and he works alone.  He was paying for all his meds himself and buying them from Canada because they were way cheaper.
Then he decided to go on Remicade.  BUT....it was WAY expensive and there was no way he could pay out that much.  One of the lovely ladies here, either Carol or Joy, suggested  contacting Centocor,, as they help people with no insurance.  We did,,my son qualified for the treatments... FREE... Remicade works great for him, and he doesnt take any other pill.  All his sores on his arms healed up, and he has more energy.  It is a true blessing.
Now for the question.  If this health bill passes and he has to buy insurance, or get fined, will the insurance pay for this Remicade,,and pay ALL of it?  He doesn't mind buying the insurance,,but if he does,,and it won't pay for the Remicade, what good is it.  Then, if he does have insurance,,he may not qualify for the Centocor help.  What a mess!!  He is petrified he'll have to quit the infusions.  He is doing so well...has no side affects at all.
No flu like symptoms,,no achy joints,,, and he is 41 years old.  His business is physically demanding and he feels good now.  I'd sure hate to see him have to get off the Remicade.  It lowered his immunity to more normal.  He doesn't take any extra vitamins or even a probionic,,he just eats pretty good.  He is slender, and burns it off from working.   I know people with pre-existing conditions may be able to buy the insurance now,,but  at what cost?   Did you know that you can buy Remicade from Canada at about $650.  vial??   My son needs 5 vials,  so he could buy it on his own
at about $3,250  per infusion.  Very high cost to pay every 8 weeks, but still cheaper then what the Remicade costs here in America.  Boy, is there an answer here? HELP.

jujub
Forum Moderator


Date Joined Mar 2003
Total Posts : 10407
   Posted 8/21/2009 10:50 AM (GMT -6)   
I think virtually all insurance policies cover Remi now. The amount you pay is dependent on your policy, where you get it and how it's billed. At a doctor's office-based infusion center, it was billed as office treatment and I paid $35 for each infusion. At a hospital infusion center, I pay for it up to my annual out-of-pocket maximum (1500), then insurance covers it all. My first infusion of the year covers my total out-of-pocket, so the insurance covers everything after that. I had a "free" knee replacement this year because of that.

For my last infusion, the hospital billed a total of $13,733. The insurance paid the discounted amount of $6866. I paid nothing.
Judy
 Ulcerative colitis forum co-moderator
 
Moderate to severe left-sided UC diagnosed 2001. Flared for 5 years, finally in remission with Remicade since March 2006. Colazal,  Remicade, Nature's Way Primadophilus Reuteri.
Avascular necrosis in both shoulders is  my "forever" gift from steroids.
Chronic joint/connective tissue/muscle pain; TKR 05/09 
"My life is an ongoing medical adventure"
 


Scrap Girl
Veteran Member


Date Joined Jan 2007
Total Posts : 653
   Posted 8/21/2009 11:47 AM (GMT -6)   
I don't think anyone really knows how this healthcare reform is going to pan out, which is why a lot of people are apprehensive.
Diagnosed with UC in Feb. 2005
 
Colazal (9 a day)
Folic Acid
Biotin
Calcium
Remicade


cra43
Regular Member


Date Joined May 2008
Total Posts : 172
   Posted 8/21/2009 1:00 PM (GMT -6)   
Thanks Judy and Scrap girl for your input. I guess we will just have to wait and see how this health bill goes, and how the folks with pre-existing conditions,,PLUS a lower income are going to cope with the new plan. I have a feeling it will cost plenty,,first just for the Ins. premium itself,,plus the deductible you have to pay first,,,then any co-pays,,if any.
One thing is certain,,,this darn disease is one expensive, never ending cross. And you get it, through no fault of your own. My son was always very healthy, ate right,,etc. then out of the blue..the loose mucosy stools and pain started when he was about 33 years old,,and he had no clue what was going on. Rotten luck, (and bad genetics) my husband has it too, only his has been in remission for the last 9 years.. THANK GOD!! OK good luck to all with it.

Meesh
Veteran Member


Date Joined May 2006
Total Posts : 619
   Posted 8/21/2009 2:44 PM (GMT -6)   
There's no official health plan being considered yet. Most of the information floating around out there is MISinformation so who knows what is going to happen? It can hardly get worse than it is though, but what will be covered and what won't be covered is anyone's guess.

The things both parties agree is that insurance companies will no longer be allowed to drop you if you're sick and they'll have to accept you and pay for your pre-existing conditions. So that should help you son qualify for insurance. Also in general agreement would be affordable insurance with subsidies to ensure that affordability.

I do get a kick out of these old coots on MEDICARE standing up at these town meetings and telling their representatives to keep the government out of their health care. Yeah grandpa, keep the government out of your government provided health care. Sheesh.
47 yr old female, dx'd UC April 27, 2006; mild arthritis in lower back, dx'd May 2008; Osteopenia dx'd 6/08 Achieved almost-remission mid October 2008 (rectum still inflamed). Having surgery in January 2010.

17 Remicade infusions (6 weeks sched: 1st: 7/21/07; most recent: 7/18/09; Current meds & supplements: Lialda, 4 tabs in the morning; 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; Roweasa; Venofer (iron) injections Dec '07; Imuran (extremely bad reaction 2/07); Protonix; Lexipro; Xanax


fruitgirl
Veteran Member


Date Joined Feb 2009
Total Posts : 7150
   Posted 8/21/2009 4:45 PM (GMT -6)   
I'd take the government provided health care program that senators and such get ANY day!
Status: Remission since May 2009!
Symptoms began in November 2008, ~4 weeks after giving birth to my son.
Diagnosed with pancolitis on 1/30/09
Currently meds: Apriso (4 0.375g pills ONCE!! daily), mesalamine enema twice weekly, Natural Factors Ultimate probiotic 12/12 Formula, and Zoloft (currently tapering; 12.5 mg).


Peety
Veteran Member


Date Joined Mar 2008
Total Posts : 2855
   Posted 8/21/2009 7:05 PM (GMT -6)   
If there is an individual mandate, anyone who has low income will be subsidized. And the insurance companies have agreed to not consider pre-existing conditions, in exchange for the prospect of having many more customers (with a mandate). That might be an oversimplification, but generally, don't worry about it! The drug companies will continue their programs for the time being. And I haven't heard of anyone whose insurance didn't cover it (and we'll have even more insurance choices).

Members of Congress just get blue cross/blue shield, no different, no big deal. They are just lucky to be in the very large pool of federal employees.

There is lots of good stuff in health reform. It's my job to study it, all day long. Fascinating.
49 year old female attorney, diagnosed UC/pancolitis 1985. 
Asacol maintenance for 20+ years; 
Prednisone & Rowasa for flares. 
Food sensitivity test by Naturopath showed wheat/gluten, other intolerances, helped some. 
Remicade started April 2009 (Humira denied) and doing great~ learning what normal is~ wow


summerstorm
Veteran Member


Date Joined Aug 2006
Total Posts : 6571
   Posted 8/22/2009 12:38 AM (GMT -6)   
when i had UC i was doing remicade, and my insurance covered it, but it was supposed to be like 150.00 or something (this was not too long after it had come out) and had JUST been approved for UC, and this company access 1 (i think) paid part of it if i would answer questions every few weeks and let them help me remember appointments. Basically, they were following me,making sure i was doing the appts the way i should and taking info for research and stuff.

On a side note, if you start a drug, or are on a drug, esp if you are pregnant, check the internet and see if anyone is studying how those drugs affect you or the baby. Sometimes they will pay for part of the drug.
WHen i was pregnant i was taking lamictal and phenobarbital, well the companies arent allowed to test on pregnant women, so its hard to get info. But by doing that i helped them to see what kind of effects those drugs would have.
ALl they did was have me fill out some papers and answer some quesitons. IF there had been something they wanted more info on, like a problem with the baby, they will pay for those tests and that care. Alot of other companies will do that too. Its not the drug companies that do it always though.
I hope that made sense
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