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How much do you pay for Remicade

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Posted 12/30/2010 5:04 PM (GMT 0)
Thinking of trying Remicade. Got some sticker shock when I was told each infusion would cost $5000, of which 10% would be my out of pocket coinsurance.

Does that sound a little high? I weigh 210 pounds... apparently how much you need for each infusion  goes by your weight.

Posted 12/30/2010 5:06 PM (GMT 0)
Does that 10% go towards your out of pocket yearly max, or not? If it does, then your insurance should cover 100% after you reach that max, I think.

Whatever the case, I hope you get something figured out!
Posted 12/30/2010 5:14 PM (GMT 0)
Not sure about the yearly max out of pocket. I am on my wifes insurance since I am self employed and she is starting a new job on Monday at the Mayo clinic (she is a nurse). The information she has says that copay amounts do not count against your yearly maximum, but technically the 10% is "coinsurance", not sure if that is the same thing.

She has a meeting with HR on her first day, so she will try to find out for me. At $500 a pop, this could really add up.
Posted 12/30/2010 9:16 PM (GMT 0)
I take 4 vials of remicade (5mg/kg) and the cash price of the remicade alone is $3300. My insurance applies their discount and it goes down to $2600. Then, I pay 20% of that $520. That's for the drug only. (I think you would be taking 5 vials if your RX is for 5mg/kg)

Then comes the infusion fee: $394. My plan applies their discount and it goes down to $267. Then I pay 20% of that $68.00.

So, for me it's $590ish out of pocket for each infusion. And it does apply to my yearly out of pocket.

It's a lot cheaper to get an infusion at an infusion center or in a doctor's office than at a hospital in most cases. Ask you doctor for options as to where to get it done and call them and ask how much they charge before you even schedule an appointment. And of course make sure they take your insurance! Also, be sure you use the preferred provider for the Remicade too, it will be cheaper.

Also, look into the Remistart program! if you are accepted you can get the first year of drug covered!

Good luck! :o)
Posted 12/31/2010 4:19 AM (GMT 0)
Mayo seems pricey compared to what you pay. Since my wife will be working at Mayo, there is no problem with them accepting the insurance!!

If copay and coinsurance don't count against the yearly out of pocket cap, I don't know what would, since that is the only out of pocket you have when you have insurance.
Posted 12/31/2010 12:57 PM (GMT 0)
so far I haven't paid for any of my infusions. When I first started I used to pay the $50 co-pay at my GI's office when I saw the nurse for my infusions but now I don't get charged anything when I see the nurse as I'm not seeing the doctor.
Posted 12/31/2010 6:07 PM (GMT 0)
My charges for Remicade are applied to my max out-of-pocket, and I will always hit the max. I use a flexible spending plan to pay my portion pre-tax and also to spread out the costs (I pay into the plan with each paycheck and can start using what I scheduled for from day 1, even if the balance isn't up yet). I think the max you can put into flexible (pre-tax health) spending went down this year, unfortuately, to something like $2500/year, even though my out-of-pocket max is higher than that. So I will have some extra bills this year.

I think my infusions charges are $8K, then reduced to $3-4K via arrangment with BCBS, then insurance pays either 80 or 90 percent until I reach my max. I get my Remicade infusions at my GI's office infusion center, I think everyone has found they are less expensive than hospitals. I'm also comfortable there, the infusion nurse is great and sometimes my doc drops by to say hello.
Posted 1/1/2011 12:35 AM (GMT 0)
Remicade does go by your weight. I weigh 175 and take 4 100mg viles. I am in Canada and they cost my insurance company $1000 each. So it is $4000 per infusion.
Posted 1/1/2011 12:36 AM (GMT 0)
i have crohn's diesease and take remicade its 7000 every treatment. I know there are applications to fill out for companies to help you pay for them. One you pay 100 each treatment and the other you only pay 30. My infusion place told me about these programs. I can get you some more information on them if you would like, i am sure that the place that u get your treatments have similar things.
Posted 1/1/2011 12:50 AM (GMT 0)
Your portion of the Remicade cost will almost definitely apply towards your yearly  max.  I am almost 100% sure although I can't really say that without reading the fine print.  The out of pocket costs are made up of copays, medical treatment, etc... until the deductible is met.  So I can't imagine this not being the case.  I, like Peety, also use pretax dollars to pay for these copays.  Peety is not correct in the amount.  I took out 4k in pretax dollars because my max out of pocket is 4k annually.  When you use the flex spending account it's like getting a 25-35% discount depending on your tax bracket so I would definitely look into it at the HR dept at Mayo.

 

Happy New Year,

 

MyUC

Posted 1/1/2011 12:59 AM (GMT 0)
I dont pay anything if I've met my yearly 500$ deductible. I do pay 350$ a month for insurance though.
Posted 1/1/2011 6:09 AM (GMT 0)
Our max out of pocket will be only $1000, so I hope the 10% coinsurance applies towards it. Will find out on Monday when she meets with HR. The flex spending account is a great idea too since I am in a high tax bracket being self employed. I didn't think about that so thanks for the advice.
Posted 1/1/2011 10:36 PM (GMT 0)
Your welcome.  I would at a minimum take out 1k in your FSA but you could consider more for the OTC although new rules require you doc to just sign a letter of medical necessity for them.  It's still free money on the table for the taking.  Good luck, it sounds like you have a good plan now. 

 

MyUC

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