Remicade - Over $3K a month! Help please

[lmjjc]

I've been on Remicade for about 5 years now for ulcerative colitis.
At first, it was a HUGE pain to get our insurance to cover it. They refused, even though the doctor said it was medically necessary (I was hospitalized, and it was the only thing they gave me that made any difference) At the time it was only approved for Crohn's, not U.C., so I'm not sure if that was part of the problem or not.
We applied for the program mentioned above - an assistance program by the manufacturer - and we were turned down because we made too much money. (It would have taken my husband's whole paycheck at the time to pay for each dose, and I only work part time)
My doctor wrote 2 more letters to the insurance company, and they finally agreed to cover it. I think at first they pre-approved it for 3 doses, then for 1 year at a time.
The moral is - get your doctor to keep writing letters - sometimes it takes a few tries. :)

Oh, and I don't pay a doctor's office visit fee or Rx co-pay when I get each infusion, but I am billed for up to my personal deductible limit at the begining of each new insurance year. (our insurance renews each Sept)

HTH

[Tracy63]

I feel ya! I am on Remicade for Crohns right now and it breaks us up! Each infusion is about $7k here and we pay about $1500 every 8 weeks until we meet a $7500 oop for the year. The price stinks but this is a miracle drug for me.

Oh, and I get my infusion at a Cancer Institute. This is the only place they will administer it to me in the area. This may affect the price as well.

[ckhen]

Call Centercore and ask about the Remistart rebate program. 1-877-324-2145. This is a rebate program depending on household income they will pay your co-pays for you (except about 100.00$ per infusion) until your insurance kicks in at 100%. I've been on it for 2-3 years for Crohns..it has helped a lot! Every 2 years or so you need to re-up. I found this out after taking 2 Remi treatments this year......so they will not be covered. Also our household income increased this past year....not by much, but enough to kick me out of the rebate program. It worked so well for me....now I have to find another drug I guess. I don't know too many people who can afford 500-800.00$ copays every 6- 8 weeks. Good luck to you......Crohns andc arthritis don't have to be debilitating!! I've had it for 30+ years. You and your daughter are in my prayers.

[rbunnymom]

Originally Posted by ckhen Call Centercore and ask about the Remistart rebate program. 1-877-324-2145. This is a rebate program depending on household income they will pay your co-pays for you (except about 100.00$ per infusion) until your insurance kicks in at 100%. I've been on it for 2-3 years for Crohns..it has helped a lot! Every 2 years or so you need to re-up. I found this out after taking 2 Remi treatments this year......so they will not be covered. Also our household income increased this past year....not by much, but enough to kick me out of the rebate program. It worked so well for me....now I have to find another drug I guess. I don't know too many people who can afford 500-800.00$ copays every 6- 8 weeks. Good luck to you......Crohns andc arthritis don't have to be debilitating!! I've had it for 30+ years. You and your daughter are in my prayers.

Thank you for posting this information. I am sure it will help someone.

[sosimplenow]

I so appreciate all of information and support here. It has been a struggle but by using various programs, some mentioned here, we have been able to cope. If anyone needs help or support, I now have a lot more resources to share!