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.