Insurance denied Remicade; approved Inflectra

My Blue Cross/Blue Shield insurance denied Remicade, but said I could try Inflectra, which my doctor's nurse told me is "biosimilar." I thought I had really great insurance, too. Anyone have info about Inflectra? I'm down to 10 mg pred again and not really having any symptoms. Maybe a few extra BMs a day than normal (3-4), but nothing else.

Yikes Sara I have Blue Cross/Shield and they approved Remicade. I am surprised that this happened with them. Have you called them? I mean I don't think it should be that much of a deal because all the drugs have different mechanisms that work differently in each person. Humira and Remicade are sister drugs yet some people fail one and do better on the other. Have you tried to just wean off of the prednisone yet?

Sara, my MD put me on inflectra instead of remicade, as it is a biosimilar/basically the same thing with an add-on. There isn't a ton of follow-up from people on here who have tried it -- just lots of questions.

I just did my third induction dose this past Friday, and I am doing well. I take a low dose of Imuran with the inflectra. They worked really fast in ending my D and bleeding (like, by the second induction dose at week 2). I still have some body aches, but it certainly takes longer to get into remission than a few weeks, so I am happy with my progress. I was not on any prednisone or other steroid when I started -- the Humira had failed (antibodies) and I spent a good 3-4 weeks fleeing to the bathroom before I got switched over because I refused to take prednisone again.

Different insurances approve different things at different times... I'm convinced a lot of the approval process has to do with the mood the insurance person is in when they approve/deny your request.

I think some follow up things for you to look at would be:

1. Is the insurance company going to always deny it or will they approve it after you have tried other medications and they dont work? For my insurance, they wouldn't approve Entyvio until I tried either Remicade or Humira. I went on Humira, it didn't work, and then insurance approved Entyvio. Try to find out if the insurance just has a process to follow or if they will never approve it.

2. See if your doctor will call on your behalf. I know my doctor told me when we first applied for Humira that if they deny the nurse's request, he will call the insurance company and get it approved. It never came to that, but he said a lot of times doctors have a better chance at getting something approved that originally gets denied.

Inflectra and remicade are extremely similar, so much so they're biosimilar (closest thing to a generic that there is for biologics). I wouldn't worry, try it and you should get very similar results but with a much lower cost