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How Do You Pay For Your Remicade?

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Crohn's Disease
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Posted 10/6/2011 1:35 AM (GMT 0)
My GI is considering putting me on remicade.  I am on Medicare.  Since Remicade is given in a hospital, I am assuming my Medicare Part A or B will pay for most of it 80 percent.  That means I have to pick up the remainder?  I am on social security and that would be my enitre check. 

Am looking for someone who knows how this would work and can give me some pointers.  Thanks.

Posted 10/6/2011 1:44 AM (GMT 0)
Remicade has a financial assistance program, I think it is called Remistart.

Can't offer any advice on what you need to have to qualify and all those specifics, but best of luck!
Posted 10/6/2011 2:00 AM (GMT 0)
I'm not sure how Medicare categorizes Remicade.

Would they qualify the Remicade itself as a drug, subject to Rx benefits, and the hospital related facility charges as Part A/B, or does the hwole thing become Part A/B?

Do you have a medicare supplement policy or a Part D plan?

According to the Remicade website, "Medicare carriers and the claims processors for all states cover infusions of REMICADE® in doctors' offices and hospital outpatient facilities. The traditional Medicare Fee-for-Service Program does not cover infusions of REMICADE® when they are provided by home infusion companies or retail pharmacies."

It doesn't go into details as to how it is categorized or how much is covered.
Posted 10/6/2011 2:21 AM (GMT 0)
A bit more searching, and it seems that it is covered as a Part B benefit, so yes, the Part B deductible and coinsurance would apply.

There is the remistart program mentioned above that you could look into to help with coinsurance.

Medicare Supplement insurance, if you have it.

Also, it seems that the price varies quite a bit by provider, whether they accept medicare, and whether they would send you to a large infusion center or for-profit hospital setting vs. having it done in a smaller setting or a not-for-profit hospital.
Posted 10/6/2011 1:04 PM (GMT 0)
@ clonehead
Thanks sooooo much for looking into this. I feel better now, knowing that this isn't part of my prescription drug plan, but rather part B. I have Medicare and a medigap policy so I guess I need to look into my medigap policy and see what they will cover and then the medistart. Thanks again.
Posted 10/8/2011 2:02 AM (GMT 0)
You're welcome. Yes, your coverage could vary depending on which medigap plan letter you have, but I believe they all cover the 20% part B coinsurance. Some plans also cover the deductible. Your policy and/or insurance company should be able to confirm those details.

And you should verify with the hospital or infusion center beforehand that they accept Medicare.
Posted 10/8/2011 4:37 AM (GMT 0)
You can also go to the Remicade website for information on the patient assistance program. You then can download forms to fill out and send back. They will make a decision and let you know if you are eligible for assistance with the cost of treatment. I did it myself for help with the cost of Humira and am now waiting for a reply. My doctor said that the companies are very generous for those who do not have any insurance at all or inadequate insurance to cover the costs.
Posted 10/7/2015 12:05 AM (GMT 0)
A lot of ppl are uninformed here. I have severe crohns disease among other things. RemiStart will NOT help you if u are on Medicare.. Medicaid.. etc. I am 43 and suffering. Doubled over. All meds have been tried. I have Medicare.. they wanted to try remicaid as a last straw.. no one will take my insurance for the infusions. So I am sure I will lay here while my insides are being eaten up and die.. I wish you the best.. for me there are no options left..
Posted 10/7/2015 3:42 AM (GMT 0)
tiger5230 us right. It says it right on their website that they do not help you when it's just medicare or medicaid. Just regular insurance.

Even then they aren't easy to do with. After a fight to get my insurance to cover the infusions for months, then I've had to fight Remistart to start putting money on this card they gave me. I'm still waiting and I've been on it for 8 months. I think I'll get it soon. But then I know it will only help cover the medication portion, I don't know what I'm going to have to pay for infusion center costs. It's a pain.
Posted 10/7/2015 12:02 PM (GMT 0)
I found a site.. if ur below income levels they say they'll help but I'm not sure about it yet.jjpaf.org Johnson and Johnson patient assistant foundation. .. I'm sorry if I'm so unhopeful. I'm in a lot of pain.. and I just feel no one cares.. good luck.
Posted 10/7/2015 12:50 PM (GMT 0)
When I started on Remi, my insurance covered most of it. I had co-pays ranging from $10 to $85 per infusion, depending on where I got my infusions. I never could exactly identify the criteria for different charges. Since I've been on Medicare, I get my infusions in an infusion center. Medicare pays 80% and my prescription coverage from my former employer pays the remainder. I have no co-pay.

There are some advantages to getting old!

Also, I believe you cannot use the drug company programs such as Remistart if any government program is paying a portion of your bill. I still don't understand why this is, but this is what my pharmacist told me.
Posted 10/7/2015 7:06 PM (GMT 0)
I oversaw all my parents' medical bills when they were on Medicare and Social Security. They didn't carry gap insurance, but chose to put that money in the bank and pay the deductibles themselves and probably in their case, it was cheaper for them. Whenever they were hospitalized, the hospital would always send a packet of information for applying for extra assistance if they needed it. Medicare repriced all the charges, sometimes significantly, but you probably already know that. Daddy's last hospital bill was over $100,000, but Medicare only allowed $15,000, and they paid most of that.

If I were you, I'd contact the hospital or infusion center's financial office and talk to them about what's available to you in the way of financial assistance to cover costs of the infusions.
Posted 10/11/2015 1:29 PM (GMT 0)
Even though remistart does not give assistance to Medicare or Medicade patients. You can call and they may be able to assist you anyways. Also the hospital may be willing to cover some of the costs. I doubt an infusion center would give a large discount bit some hospitals are really accomadating
Posted 10/11/2015 5:00 PM (GMT 0)
I should have stated above that when Medicare adjusted (or repriced) the $100,000 hospital bill to $15,000, they paid most of the $15,000 and the rest of that large bill was written off and the patient only pays a percentage of the allowed $15,000.
Posted 10/13/2015 2:48 AM (GMT 0)
Hi, I just went down this road a few weeks ago, the company J & J was of no help whatsoever, was denied any assistance, I even submitted an appeal, I was told NO, and do I need it spelled out, they were very rude and uncaring. Just searching other options, (Entyvio) and the best estimate I got was $850.00 per Remicaid infusion with Medicare, not going to be able to pay that :(
Posted 10/14/2015 12:03 AM (GMT 0)
If you do it in a hospital they may be willing to discount it.
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