Remicade Cost

Just found out that my health insurance company (Blue Cross) wont cover my remicade infusions...at all. Apparently they dont cover it for colitis patients, I'm going to try to get coverage through the trillium drug program, but just in case was wondering if anyone else is in this circumstance and if they have any idea what the average cost is per infusion in Ontario?

Thats confusing :/ Im covered under my fathers insurance plan with loblaws through blue cross because im still a student and the person I have checking all my benefits for me today said that Blue Cross wouldn't approve me for it or cover Remicade at all for colitis treatment...i guess maybe im just lucky?

I would do some more investigating, because I am also a student under my dad's insurance (Blue cross). Maybe who ever you spoke to has no idea what they are talking about.

Blue cross is not one company. A couple states actually have two companies licensed by BCBS. The companies often offer different polices that have differing coverage.

I just found out today from my bioadvance coordinator that its not that blue cross specifically doesnt cover remicade, but that my dads contract with them through work doesnt for some reason. I have other insurance coverage under Great West Life that will hopefully be covering 80% and i think i can get the rest through Trillium, idk im filling out the forms for it today but my GI told me that we will get it all figured out somehow!

I have had three different insurance plans with remicade one i didn't pay anything one I had to pay total 3500 and remistart covered it and now this new plan my husbands work put us on wants me to pay up to my max which is 7,900.00. Insane... Thats all I have to say. I am sure remistart will cover some of it but they are not going to cover that much. There is a lot of programs out there to help but most of them will not cover remicade for UC just for crohns...

I am a student and have my Remicade covered by both my parents plans - Greenshield and Great West Life. I have only had one infusion but I can tell you that the receipt I was given after my first treatment was for $5600. So I would assume that's approximately how much it will cost for each trip. I think it also depends on the dose they are putting you on.

Supposedly if it is going to help,  you generally DO feel some benefit quickly so it sounds like a very good thing that with one infusion you are noticing something for the better.  Hubby had 4 altogether and nothing at all so it was stopped....here's hoping this is the answer for you!!!

There is a huge difference in Remi cost depending on if it is done at an infusion center or a University hospital. For us it was 14k (univ Hosp) vs $5800. Doc wrote a compelling note to BC/ BS of IL. and they covered the infusions for UC. Our out of pocket is 10k , so life is no picnic, but I am grateful for any coverage as I would have to cover my baby somehow. Premiums have skyrocketed, but Remistart has helped a lot. Good program. This is liquid gold,and if if works for you, may you will find a way to get it.

I used to have Blue Cross and never paid for my infusions either.

Now I have United and it's pretty similar, I have to pay about $100 an infusion

I am really freaking out right now.  We also have BCBS, and my husband just had his first Remicaide infusion 2 weeks ago.  We are registered for the Remistart program, and have received the Visa card, although I must admit that I haven't completely read the paperwork to understand the program.  Our BCBS was supposed to pay for the services at 80% after the deductible ($2000) is me.  We have a $5500 max out of pocket for each calendar year.  By chance, I was looking at my claims online today, and noticed that the hospital billed our BCBS $42000 for the initial infusion.  My jaw fell to the floor.  I recently had an 8 hour surgery in which 4 fistulas were repaired, a hernia was repaired, and my ileostomy was reversed.  This was followed by a 2 week hospital stay, and the hospital bill for that stay was less than the cost of my 1 Remicaide infusion.  Obviously, my BCBS is only going to pay 80% of the customary and reasonable amount, and anything above UCR will be written off by the hospital.  We live in a rural area, and local healthcare options are limited, but I really do wish I had another choice for my infusion location. 

 

Hey Chris,

I was just talking with a patient at my clinic, and she recieved remicade for rheumatoid arthritis. She went through trillium and said that when she went to trillium they wanted her on 8 week intervals, and she complained that it took a while for them to process claims and they always find something missing eveytime she re sends in the documentation. I do believe that she was covered, although it was a hassle, and she also mentioned that a note from her specialist may help her get the infusions back to her 5 week interval. so maybe a note will help? However, im sure its not like that for everyone. I know also that some insurance companies only cover a certain amount of infusions per year, or the plan has a cap for remicade. Hopefully you get it worked out and remicade can work again for you!

good luck

Totally bizarre how the bioadvance reps are all in your face with the remicade. When we discussed with my daughter's GI, we suddenly started getting emails from the bioadvance lady and I was creeped. Anyway, she pushed it through our insurance (Great West Life) in a day and a half. I guess they know what they're doing. Turns out we're not getting remi for moment but it was really easy for us to get approval through the rep. We were also advised to apply for trillium but what a headache. Hopefully never comes down to that. GWL does only cover 80%.
BTW, I also found it very creepy how the GI and nurses kept telling us that we could not have this drug until insurance approval. Would they make uninsured people wait until trillium came through? I just don't like to get a glimpse into this side of health care.