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Cigna not covering remicade after june 30th.

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Posted 6/15/2021 8:46 PM (GMT 0)
Hello,

I have Cigna insurance and they sent out a letter saying they won’t be covering remicade after june 30th and are suggesting bio similar drugs.
I just started remicade a couple of months before (in march) and i got into remission after being hospitalised for 10 days. Can anyone suggest next steps to continue to stay on remicade? Is it good to get enrolled in patient assistance program now?
Posted 6/15/2021 10:56 PM (GMT 0)
This is distressing to read. You would have to have your doctor try to appeal the medication change with your insurance, but he will need to have a compelling reason why he doesn't want you to use a biosimilar.

I have seen a few people here mention that they use a biosimilar, but you are the first I have seen being forced to switch from remicade. The others started the biosimilar to begin with.

You could contact Janssen to see what they suggest. Co-pay assistance only will cover up to $20,000/year, but they may have other programs for when insurance won't cover it at all.

Please let us know how you make out
Posted 6/16/2021 12:00 PM (GMT 0)
I’m not on remicade. But it has been discussed as an option for me.

I have Cigna. I hate to see this post.

I’m wondering why this would occur. I wonder if Cigna asked for a kick back from remicade and they said no, so Cigna said, ok…see ya.

From some of the online costs charts I have seen, all these drugs are outrageously expensive but they all seem to be in the same range.
Posted 6/16/2021 1:29 PM (GMT 0)
If you are being offered Inflectra it is the biosimilar to Remicade. A few years ago a lot of insurance companies stopped paying for Remicade & switched patients to Inflectra. Inflectra is much cheaper than Remicade. The crohns forum had several people make the switch with success. If I were in your shoes I would try the Inflectra rather than switching to something totally different.

Sorry this happened, but saving a dollar is what insurance is all about.
Posted 6/17/2021 4:11 PM (GMT 0)
Sad to read this! We buy health insurance to help us cover the cost and stay healthy not the opposite! I used to be with Cigna, they refused to cover my medications too!
I do believe that people with chronic diseases should be able to have a special federal health program.
Posted 6/22/2021 9:25 PM (GMT 0)
While trying to refill my oral brandname med recently via Express scripts, their agent mentioned to me that they merged with Cigna last year. I think we chronic patients have repeat Rx hassles due to a lot of mergers/acquisitions going on among the pharmaceuticals AND the private health care insurers, which benefits their stockholders while potentially harming us or definitely inconveniencing us + raising our stress levels. / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)
Posted 6/23/2021 5:31 AM (GMT 0)

dsmk said...
Hello,

I have Cigna insurance and they sent out a letter saying they won’t be covering remicade after june 30th and are suggesting bio similar drugs.
I just started remicade a couple of months before (in march) and i got into remission after being hospitalised for 10 days. Can anyone suggest next steps to continue to stay on remicade? Is it good to get enrolled in patient assistance program now?

I am very familiar with this situation, but good news, YOU DONT HAVE TO SWITCH! I kinda do this Monday-Friday, so listen closely. Call your doctors office, tell them you don’t want to switch to a bio-similar and you want to stay on remicade. Tell them they will have to submit a Letter of Medical Necessity to Cigna specifically stating why your condition requires you continue therapy with remicade. Since remicade has dropped off Cigna’s formulary (fancy word for list of preferred drugs) your doctor will have to submit a “Formulary Exception Request” along with the Letter of Medical necessity. If the nurses are confused have them contact their Field Reimbursement Access Specialist or their Janssen sales rep. If your doctor’s office staff is willing to do the leg work, there’s zero reason you can’t stay on a medicine that’s working for you. Trust me, I’ve seen this overturned many times already.
Posted 6/24/2021 2:58 PM (GMT 0)
I am going through something similar with Stelara. After being on it monthly and finally reaching remission my insurance company has declared they won't cover it monthly because the FDA recommends every two months. There's been a big long shuffle of paper between my doctor and the insurance company. Yesterday I was told if you appeal twice the insurance company will usually cave. What a gigantic waste of time and effort, not to mention stress that we really don't need!! Hope you can successfully appeal!!
Posted 6/24/2021 6:33 PM (GMT 0)
😳 Srsly we ought to be able to prosecute the insurance companies for the stress they put us through!
Posted 6/24/2021 10:39 PM (GMT 0)

tiredofallthispoop said...
I am going through something similar with Stelara. After being on it monthly and finally reaching remission my insurance company has declared they won't cover it monthly because the FDA recommends every two months. There's been a big long shuffle of paper between my doctor and the insurance company. Yesterday I was told if you appeal twice the insurance company will usually cave. What a gigantic waste of time and effort, not to mention stress that we really don't need!! Hope you can successfully appeal!!

Yep, it's a total headache dealing with that kind of crap. And it's even worse when your doctor's office isn't very helpful with that sort of thing!
Posted 7/19/2021 8:43 PM (GMT 0)
Were you able to find a way to stay on the remicade?

I have Cigna as well and have been on remicade for over 15 years and can not get them to budge. It has been only thing to ever work for me too.

Hopefully you had a better outcome!
Posted 7/21/2021 12:51 AM (GMT 0)
@JJ53 - my insurance denied remicade and i had to go with inflectra
Posted 7/21/2021 2:44 PM (GMT 0)
Looks like Cigna is covering the bio-similar called Avsola only. My question would be, have there ever been studies that show bio-similar biologics work just as well?
Posted 7/21/2021 4:05 PM (GMT 0)
Have you tried contacting Jannsen, the manufacturer of Remicade, about their payment assistance plan while your are fighting with Cigna?

Sharon
Posted 7/21/2021 4:45 PM (GMT 0)
Jansen offers no assistance unless insurance is willing to pay a portion of the medicine.
Posted 3/24/2022 6:02 AM (GMT 0)
Hi Everyone,

I realize that it has been a while since this post was last active, but I've found myself in a similar situation now (with HealthNet). After 5 years of good health on brand name Remicade they are forcing a switch. My doctor and I are doing our best to fight it, but it's not looking good at the moment.

Were there any success stories in how to stick with Remicade? Or, just as importantly, any reasons to resist the switch to a biosimilar (other than the scare factor of rocking the boat)? It is so upsetting to feel forced into this situation; I'd hate to feel like this switch precipitated a flare.

Thanks for your help!
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