I’m concerned that Remicade is being dropped by my insurance and waiting to confirm. I read that the 3 big prescription providers are switching to biosimilars. I’m up for insurance approval this month. I’m waiting to hear from BCBS. I have private insurance .
Thanks
T
diagnosed proctitis April 2016 s/p a c diff infection age 53
Nov 2017- ?Crohns colitis to mid transverse - mild/moderate
started Humira 11/17/17, -5/18- failed Humira
started Remicade 6/8/18 - in remission per scope 11/29/18
past meds- cortifoam, canasa, rowasa,balsalazide, prednisone
Yes, but this has been going on since Inflectra came out, it's a biosimilar to Remicade. Several years ago a lot of members in the crohns forum had to switch, most of them did fine. Drs would appeal but insurance dictates in 99% of the time. Inflectra is cheaper & of course money is the object with insurance.
Take care.
Susie
Moderator in Chronic Pain & Psoriasis Forums
Take care.
Susie
Moderator in Chronic Pain & Psoriasis Forums
They did this years ago in europe (where biosimilars have been around for longer)...in fact I remember my hospital even switching everyone from one biosimilar to another in 2019 (remsima to inflectra). Our health service is funded differently than the US (part insurance, part nationalised) but it all comes back to the same thing - noone wants to pay for the original brand if the biosimilar is half the price and just as effective. As far as I understand most people do just fine with the switch. I did meet one girl who got joint pains after she switched - she was allowed to go back on remicade (and her joint pains went away).
PS there are several clinical studies examining the effect of switching between the original drug and biosimilars, so this is not a case of insurance companies doing something without medical justification.
One example: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8972297/
In the end it is to our advantage that biosimilars exist as it creates competition in the drugs market and forces the price down (also for remicade). That in turn may allow more patients to access biologic treatments (don't forget that outside the US it can be much more difficult for patients to be approved for, or have access to, a biologic.)
One example: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8972297/
In the end it is to our advantage that biosimilars exist as it creates competition in the drugs market and forces the price down (also for remicade). That in turn may allow more patients to access biologic treatments (don't forget that outside the US it can be much more difficult for patients to be approved for, or have access to, a biologic.)
Inflectra is less than half the price of Remicade (actually almost 1/3 the price of Remi). I don't like being forced to change something that has me in remission after it took me so long to get here, but the only option I was given was to go back to every 6 weeks and stay on remi or go to inflectra and keep every 4 weeks. Since 6 weeks on remi wasn't enough for me it really wasn't much of a choice. I just had my first infusion of Inflectra last week so it will be a few months before I know if it works as well as Remi. My doc said everyone he had to switch to Inflectra is doing well and the nurses at the infusion center said they have a lot of people on Inflectra who are doing well so I am hopeful. It still sucks. Bottom line is it's all about money. I was pretty surprised at the price difference.
64 yo female diagnosed UC 2013. Remission on Entyvio 10/2016-12/2017. Humira didn't do much Nov 2018. Remicade (5 mg 3/2019, 10 mg 8/2019, 6 wks 1/2020, 4 wks 4/2021), REMISSION 12/2021!! Current: Inflectra 10 mg/4 wks 1/2023, Dexilant, cocktail of meds for hypertension
64 yo female diagnosed UC 2013. Remission on Entyvio 10/2016-12/2017. Humira didn't do much Nov 2018. Remicade (5 mg 3/2019, 10 mg 8/2019, 6 wks 1/2020, 4 wks 4/2021), REMISSION 12/2021!! Current: Inflectra 10 mg/4 wks 1/2023, Dexilant, cocktail of meds for hypertension
CC I saw you had to switch and I can imagine it's scary when you don't know if inflectra is going to work as well. I hope it will be fine.
It is about the money, but in this case it's because biologics are obscenely expensive. As an example I had to spend a year messing around with prednisone and different doses of azathioprine before I was allowed to try any biologic therapy. I really lost a year of my life from that. Going on a biologic was like night and day compared with any treatment I'd been on before. I believe it's the same system in the UK and other European countries. And that's not because of insurance companies making demands, but national health services having a limited budget leading to enforced protocols. I think it's even harder in lower-income countries to access these kind of medicines.
So yes, it sucks that individuals have to switch from an established treatment that has kept them stable, but if you want to be angry at someone I would blame the makers of remicade above the insurance companies, for selling their drug at such a high price.
I just plucked the number half the price out of thin air (or from having some idea how much it costs in Europe).
It is about the money, but in this case it's because biologics are obscenely expensive. As an example I had to spend a year messing around with prednisone and different doses of azathioprine before I was allowed to try any biologic therapy. I really lost a year of my life from that. Going on a biologic was like night and day compared with any treatment I'd been on before. I believe it's the same system in the UK and other European countries. And that's not because of insurance companies making demands, but national health services having a limited budget leading to enforced protocols. I think it's even harder in lower-income countries to access these kind of medicines.
So yes, it sucks that individuals have to switch from an established treatment that has kept them stable, but if you want to be angry at someone I would blame the makers of remicade above the insurance companies, for selling their drug at such a high price.
I just plucked the number half the price out of thin air (or from having some idea how much it costs in Europe).
I was very surprised to see how much the difference in price was. If I was an insurance bureaucrat I would force the same change. Since I'm the patient it sucks. Remicade is going to have to lower their prices. They have to already be seeing loss of revenue.
64 yo female diagnosed UC 2013. Remission on Entyvio 10/2016-12/2017. Humira didn't do much Nov 2018. Remicade (5 mg 3/2019, 10 mg 8/2019, 6 wks 1/2020, 4 wks 4/2021), REMISSION 12/2021!! Current: Inflectra 10 mg/4 wks 1/2023, Dexilant, cocktail of meds for hypertension
64 yo female diagnosed UC 2013. Remission on Entyvio 10/2016-12/2017. Humira didn't do much Nov 2018. Remicade (5 mg 3/2019, 10 mg 8/2019, 6 wks 1/2020, 4 wks 4/2021), REMISSION 12/2021!! Current: Inflectra 10 mg/4 wks 1/2023, Dexilant, cocktail of meds for hypertension
I am being forced to switch too. It feels pretty scary.
Diagnosed 1987 with lower left ulcerative colitis. Hospitalized often. Mega toxic pan colitis Dec. 1999. Perforated colon and total colectomy April 2011. First j-pouch surgery March 8, 2012. Six other damaged organs removed at that time. Ileostomy reversal June 26, 2012. First half-marathon Dec. 2, 2012!
Diagnosed 1987 with lower left ulcerative colitis. Hospitalized often. Mega toxic pan colitis Dec. 1999. Perforated colon and total colectomy April 2011. First j-pouch surgery March 8, 2012. Six other damaged organs removed at that time. Ileostomy reversal June 26, 2012. First half-marathon Dec. 2, 2012!
Hope i dont have to switch . Just bumped mine from 8 weeks to every 4 and doubled the dosage . This will be my second of the every 4 weeks.
Faith
NP Thyroid 30 MG compound
Dicyclomine 20 mg as needed
Clonazepam 1.5 mg
Mesalamine enemas nightly
Zolmitriptan 5MG as needed for headaches
Propranolol 10 MG twice daily ( headaches and anxiety)
Progesterone 50 MG compounded nightly
Estradiol 1.0 MG/ Estriol
1.0MG/testosterone 0.5MG/GM. Compound
Lamictal
Humira
Simponi
Entyvio
Stelara every 8 weeks
Remicade 3rd loading dose 3/31
Faith
NP Thyroid 30 MG compound
Dicyclomine 20 mg as needed
Clonazepam 1.5 mg
Mesalamine enemas nightly
Zolmitriptan 5MG as needed for headaches
Propranolol 10 MG twice daily ( headaches and anxiety)
Progesterone 50 MG compounded nightly
Estradiol 1.0 MG/ Estriol
1.0MG/testosterone 0.5MG/GM. Compound
Lamictal
Humira
Simponi
Entyvio
Stelara every 8 weeks
Remicade 3rd loading dose 3/31
poopydoop said...
It is about the money, but in this case it's because biologics are obscenely expensive. As an example I had to spend a year messing around with prednisone and different doses of azathioprine before I was allowed to try any biologic therapy. I really lost a year of my life from that. Going on a biologic was like night and day compared with any treatment I'd been on before. I believe it's the same system in the UK and other European countries. And that's not because of insurance companies making demands, but national health services having a limited budget leading to enforced protocols.
I think this is one of the reasons that we see less posting on this forum, biologicals are so affective at treating IBDs compared to previous medications that were available to us.
Prior to biologicals I had hospital stays that were billed over $750,000 each. So biologicals can offset costs elsewhere if it keeps us out of the hospital.
Keith
DX'd with Severe Pancolitis June 2005
Previous Meds: 5ASAs, Predisone, 6-MP. Remicade, Humira, Simponi, Cimzia & Cyclosporine
3-step J-Pouch surgery: 2013 & 2014
Current Condition: Chronic Pouchitis -- Not as bad as I thought it would be
Current Meds: Stelara
Total Hip Replacement: 12/16 -- Thanks Prednisone!!!
www.healingwell.com/community/default.aspx?f=38&m=3755226
I'm not arguing with that. I'm saying that it's standard policy pretty much everywhere else in the world to put patients on biosimilars where available rather than the original brand, because 1. it saves whoever is paying the bill thousands 2. In the majority of patients the efficacy is the same. The fact that the biosimilars cost 30% of the original (or whatever fraction it is) shows you how much excess cost there is on the original brand (Yes, they had to invest millions to develop the drug in the first place and they need to recoup those costs, but that's what the patent period is for).
I suspect that most new patients in the U.S. are now started on biosimilars if available rather than the name brands. I know for Remicade there are a lot of biosimilars to choose from. Don't know if there are any biosimilars for others.
64 yo female diagnosed UC 2013. Remission on Entyvio 10/2016-12/2017. Humira didn't do much Nov 2018. Remicade (5 mg 3/2019, 10 mg 8/2019, 6 wks 1/2020, 4 wks 4/2021), REMISSION 12/2021!! Current: Inflectra 10 mg/4 wks 1/2023, Dexilant, cocktail of meds for hypertension
64 yo female diagnosed UC 2013. Remission on Entyvio 10/2016-12/2017. Humira didn't do much Nov 2018. Remicade (5 mg 3/2019, 10 mg 8/2019, 6 wks 1/2020, 4 wks 4/2021), REMISSION 12/2021!! Current: Inflectra 10 mg/4 wks 1/2023, Dexilant, cocktail of meds for hypertension
I had to switch from remicade to Inflectra due to insurance and thankfully it was fine. No issues at all. Hope it goes well for you!
It is infuriating that these drug makers can make a slight tweak to the way the biological is delivered and then they get to extend their patent protection even longer in the US. Example: Humira.
Keith
DX'd with Severe Pancolitis June 2005
Previous Meds: 5ASAs, Predisone, 6-MP. Remicade, Humira, Simponi, Cimzia & Cyclosporine
3-step J-Pouch surgery: 2013 & 2014
Current Condition: Chronic Pouchitis -- Not as bad as I thought it would be
Current Meds: Stelara
Total Hip Replacement: 12/16 -- Thanks Prednisone!!!
www.healingwell.com/community/default.aspx?f=38&m=3755226
Keith
DX'd with Severe Pancolitis June 2005
Previous Meds: 5ASAs, Predisone, 6-MP. Remicade, Humira, Simponi, Cimzia & Cyclosporine
3-step J-Pouch surgery: 2013 & 2014
Current Condition: Chronic Pouchitis -- Not as bad as I thought it would be
Current Meds: Stelara
Total Hip Replacement: 12/16 -- Thanks Prednisone!!!
www.healingwell.com/community/default.aspx?f=38&m=3755226