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Remicade/Inflectra Rebate Programs?

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Ulcerative Colitis
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DavidEA
Regular Member
Joined : Aug 2017
Posts : 116
Posted 10/2/2018 7:40 PM (GMT -6)
Hey there,

I've now received two Inflectra infusions and each time when I went into the center, they didn't charge me anything or even mention payment. And so I thought, wow, this must all be covered, how great. When I went to pay my monthly premium, there it was: ONE infusion is $1,200! Yikes. And I've already had two, ugh.

When I was on Humira I worked with the company and my payments went down significantly. Does anyone know if Pfizer has a rebate program or something similar that helps patients. $1,200/infusion is unsustainable for anyone, even if it's bi-monthly, it's way too much.

Any tips would be appreciated. Thanks smile
D
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straydog
Forum Moderator
Joined : Feb 2003
Posts : 18865
Posted 10/2/2018 8:07 PM (GMT -6)
David, do a quick google search for Remicade's website & read about the program there. They provide a link for patients to obtain assistance. I am having major issues with my laptop tonight, so I am keeping this short. I am betting you will qualify.
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suchatravesty
Regular Member
Joined : Dec 2017
Posts : 346
Posted 10/2/2018 9:32 PM (GMT -6)
yeah -- Pfizer has a program. They will reimburse you up to $20k year for inflectra. Google it.
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iPoop
Forum Moderator
Joined : Aug 2012
Posts : 16365
Posted 10/3/2018 6:43 AM (GMT -6)
Pfizer manufactures Inflectra and they do offer a patient copay assistance program.

pfizerencompass.com said...
The Pfizer enCompass™ Co-Pay Assistance Program for INFLECTRA can provide you assistance for your out-of-pocket drug costs associated with INFLECTRA due to:
-co-pays
-coinsurances
If you are a commercially insured patient (eg, have coverage through a private employer), and are eligible for co-pay assistance, you can receive assistance of up to $20,000 per calendar year, and now may pay $0 per INFLECTRA treatment for claims received by the program as of April 1, 2018. It does not cover or provide support for supplies, services, or procedures associated with INFLECTRA. Please see full Terms and Conditions below.

To apply for assistance now, you can download the Pfizer enCompass Enrollment Form. Fill out the Patient Information, including the required fields, review the consent, and sign the form. Have your doctor complete the remaining sections, sign, and submit the form.

If you have questions or would like to know more about the Pfizer enCompass Co-Pay Assistance Program for INFLECTRA, please call Pfizer enCompass to speak to an Access Counselor at 1-844-722-6672, Monday–Friday, 9 AM-8 PM ET.

/www.pfizerencompass.com/

/www.pfizerencompass.com/patient/inflectra/right-patient-support

I would assume it works similar to Shire's Remicade program. So, I bet you can pay your bill and have Pfizer cut you a check as reimbursement. Alternatively, you can submit your insurance EOB to Pfizer and they will give you a credit card with reimbursement balance for paying your provider.

Like Shire's program, Safe bet to assume that they only reimburse for the cost of the medication itself, not the cost of the nurse's time to set the IV or monitoring you. Fortunately, the medication is 95% of the total cost.
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DavidEA
Regular Member
Joined : Aug 2017
Posts : 116
Posted 10/3/2018 4:23 PM (GMT -6)
Thank you everyone for the info. I contacted Pfizer and got the ball rolling on this. Thanks again!
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iPoop
Forum Moderator
Joined : Aug 2012
Posts : 16365
Posted 10/4/2018 6:12 AM (GMT -6)
Great, let us know how it goes.

I know entyvio's program is a royal pain in the butt for many of us. Remicade/shire has been great. No complaints on humira's/abbvie's program.
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Kulinarykidz
Regular Member
Joined : Aug 2015
Posts : 478
Posted 10/4/2018 7:28 AM (GMT -6)
The best news about the savings program is it goes towards your deductible and out of pocket max since the hospital/dr office reports it as paid by patient to insurance company. It’s a godsend for me. After 2 infusions paid by my savings card, I max our family deductible of $10,000 AND after infusion #3 it maxes our family out of pocket of $15,000. We try to squeeze all other testing and procedures for after this.
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nutmeg8991
New Member
Joined : Feb 2021
Posts : 5
Posted 2/16/2021 11:17 AM (GMT -6)

Kulinarykidz said...
The best news about the savings program is it goes towards your deductible and out of pocket max since the hospital/dr office reports it as paid by patient to insurance company. It’s a godsend for me. After 2 infusions paid by my savings card, I max our family deductible of $10,000 AND after infusion #3 it maxes our family out of pocket of $15,000. We try to squeeze all other testing and procedures for after this.

Hi! Are you referring to the payment program for Remicade or Inflectra? How you describe was how the Remicade program worked for me and I am trying to figure out whether the inflectra program will work the same!
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DavidEA
Regular Member
Joined : Aug 2017
Posts : 116
Posted 2/16/2021 11:22 AM (GMT -6)
Hey! I use the patient assistance program for Inflectra and have for the last two or so years.
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nutmeg8991
New Member
Joined : Feb 2021
Posts : 5
Posted 2/16/2021 11:26 AM (GMT -6)
@DavidEA, thanks for the reply! With your insurance, does inflectra's payment through their program apply to your deductible? Or do they just pay for the inflectra, but it doesn't count toward your dedcutible?
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Jbsand
New Member
Joined : Mar 2021
Posts : 2
Posted 3/27/2021 10:27 AM (GMT -6)
Guys, My daughter has just started her infusions this year and we have started the application process. I am curious if anyone knows the requirements. I generally understand this...

"-co-pays
-coinsurances
If you are a commercially insured patient (eg, have coverage through a private employer), and are eligible for co-pay assistance, you can receive the assistance of up to $20,000 per calendar year, and now may pay $0 per INFLECTRA treatment for claims received by the program as of April 1, 2018."

But is there an income requirement that needs to be met too? If so, any idea what that is?

Thanks,
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DavidEA
Regular Member
Joined : Aug 2017
Posts : 116
Posted 3/29/2021 10:20 AM (GMT -6)
Hey there,

I'm pretty sure YES it does count toward my deductible but that may be different depending on each individual's plan.

I do not think that showing income is a requirement for the patient assistance program. I think the requirements are an official diagnosis that shows need for the medicine and that you are on private insurance and not government assistance. You'll need to show proof of both. Once you submit your form, follow up in a week to be sure it was processed. My advice is just to keep on them until your account is active.

Once you're activated, each time your daughter receives an infusion, you'll get an EOB from your insurance with the Inflectra listed. This will list what insurance pays and what you owe. You'll fax this EOB and the claim form TOGETHER to Pfizer. You should then receive reimbursement in a week or two.

Let me know if you have more questions on the process. Good luck!
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