What's the cost of Remi after insurance?
The key thing, whether you choose humira or remicade, is to sign up for the drug manufacturer's copay/deductable assistance program. They cover most of the copays and deductibles you'd otherwise be responsible for, often limiting your out-of-pocket to as little as $5.00. There's one caveat, those rebates only apply to the medication cost itself and not to any cost of administering the medication (mostly a remicade thing, as humira is self-administered) but I'll get to that in a minute. Here's links on the programs (I've used RemiStart for multiple years, works great and has saved me a countless amount):
What do the medications cost? They're expensive brand names, considered injectable-medications under insurance policies that are ordered from one of only several mail-order, specialty Pharmacies (Expressscript
s, CVS Caremark, etc.), and have a lot more complex billing than your usual copays/deductables from your local pharmacy for pill-based prescript
ions. It's common to have a $150.00 to $250.00 copay for each month's dose, but if you use an assistance program then that can be $5.00. You might have a deductible that applies at the start of each policy year that applies (a few hundred to a thousand or so dollars), and the assistance program pays for that deductible as well down to $5.00 (meaning if you later need a colonoscopy then that yearly deductible is now gone thanks remistart lol).
If you are interested in estimated costs of Remicade, here is what I got in my explanation of benefits (EOB) a while back (does not include what my insurance covered):
1.) n/a__________Saline Injection_____$ 24.00
2.) n/a__________IV Pump/filter fee___$151.00
3.) 96413________Infusion 1st hour___$258.00 (nurses time to monitor me)
4.) 96415________Infusion 2nd hour___$ 93.00 (nurses time to monitor me)
5.) J1745________Injection, Infliximab__($2,500 per vial of 100ml) X 4 vials
RemiStart assistance would only cover copays/deductibles for item #5 in the above, which is by far the largest portion of the bill ($2,500 x 4 units = $10,000). If you accrued out-of-pocket costs for items 1 thru 4 then they are yours to pay. In the case of remicade at maintenance dosing, this bill would be recurring every 8 weeks (most common frequency). The initial loading doses are more closely spaced together at weeks 0, 2, and 6 (and then every 8-weeks thereafter in maintenance mode).
Note: remicade is weight-based dosing. I weight 155 lbs or 70 KG. For each KG of body weight I would be given 5mg/ml. Each vial contains 100 mg/ml of medication. So it would be (70X5)/100=3.5 vials amount would need. They always round up, so I am billed for the full fourth vial.
Humira, everyone receives the same dosage initially regardless of body weight. Patient response dictates whether you need more/less Humira. Humira is self-administered via the humira pen (after a nurse shows you how), so there's no reoccurring fees for a nurse at every injection. Humira tends to be a little bit cheaper as a consequence thereof, and often insurance insists on it over remicade. Remicade is anecdotally a little better in results (reiterated by many, present party included), but never proven beyond a reasonable doubt in scientific literature.
I never claim any med is side effect free. There's risk in everything, but generally the benefits far outweigh those risks. I know you said you've researched side effects some and here's my favorite read/watch on them, which actually gives the odds of side effects (something the medication insert does not). Helped me greatly when initially considering going on these meds. Statistics on risks/benefits from the Crohn's and Colitis Foundation of America:
.pdfWow -- thank you so much! This is amazingly helpful information. I really appreciate it. I am going in to do my chest x-ray today, and my GI's nurse said she is going to start pre-auth for both Remicade and Humira to see if my insurance will cover one of them.
I woke up feeling a little better. I quit smoking yesterday. It must be from that. If I get better quickly, I don't know if I should still do Remicade/Humira or not.
Thanks again for all the info. And thanks, DB, as well for the info. you shared.
34 years old; diagnosed March 2007.
Latest scope: 9-29-16: mild-to-moderate chronic and active proctosigmoiditis (infectious cause). Battled reoccuring campylobacter & c diff. Oct-Dec 2016. Healthy since Dec. 25, 2016 until I started smoking May 2018.
Current meds: Delzicol, 6, 2xday; Rowasa nightly; singular and Allegra for allergies; Xanax. Have tried Bentyl, Donnatal, and Levsin; dont help.