Another Frustrating Infusion Center Visit

Well, they only had to poke me twice today, so that part wasn't bad, but I get here at 8 a.m. this morning (2.5 hours ago), and the infusion nurses inform me that instead of the Remicade I got during the last two visits, that my specialty pharmacy had sent Inflectra for me this time (they didn't know it was Inflectra...they kept calling it the generic Remicade). I know it is a biosimilar, but I was very surprised and confused about this because no one had informed me (let alone asked me if this was okay), and I'm already signed up for Remicade's co-pay assistance program and I got Remicade the first two times, so it made no sense to me. The nurses told me they called my doctor's office and my doctor said it was okay for me to take. I was still confused though, so I said I wanted to call my pharmacy and ask about this before I took it. So, I called Walgreens Alliance (my favorite people to chat with...not) and the lady on the phone kept telling me they have only sent me Remicade and that they sent out all three of my starter doses in July. She said they would never switch me to Inflectra unless they asked me first. The nurses kept telling me what I was getting was exactly the same as Remicade, etc. Then they sent the hospital pharmacist down to talk to me (really, to convince me to just take the Inflectra since they had already mixed it and it's such an expensive drug...not my problem). The Inflectra came from a pharmacy called Bioplus, so that made me even more confused. I was then told to call my doctor's office and ask if they sent in a second script for me to a different pharmacy (BioPlus) than the one I had been using (Walgreens). So, I did that, and they had no idea what I was talking about and said they've only talked with Walgreens.

Well, eventually, the hospital pharmacist came back and told me that Inflectra with my name on it was from over a year ago when my old doctor and I were discussing me starting on it, but I never did, and I didn't even know it was ever ordered for me, let alone still sitting here with my name on it. So then he goes and looks to see if my Remicade I was supposed to get today was somewhere in their fridge and it isn't. So by now, I'm on call three to Walgreens and it turns out they haven't even shipped it yet. They had called me Aug. 26 to get "consent to ship" (which I had told them prior they didn't need to do...they asked me before if I wanted a call each time or not and i said no but it doesn't matter what you tell Walgreens Alliance because no one writes anything down, apparently). Anyway, I guess it's shipping Sept. 10. So, now will I be behind for getting my next dose in 8 weeks? The hospital pharmacist was super nice and "fronted" me some Remicade from another patient that they had in stock so I'm now getting my infusion. Maybe I should have just taken the year-old Inflectra but that wasn't what I was supposed to get and I doubt my insurance would have even still covered that since it was pre-approved over a year ago??? I feel like an idiot and just want to go home because I made a big fuss about all of this when they just kept all telling me Inflectra was the exact same as Remicade. But now that I think about it more, what if they gave me that and i ended up having to pay out of pocket because it wasn't even pre-approved for me?!

Thank you. Actually, the nurses kept encouraging me to just take the "generic Remicade," that it was the same thing, so they were not advocating for me, nor did they realize there was a problem or seem to believe me. I guess yeah, it's good they at least informed me that it was a different med though. I guess I never would have known if they had not told me.

I am surprised their pharmacy here didn't look at the date on the Inflectra or anything, especially after I started asking questions. I guess it was an unusual situation with it having been shipped over a year ago and me having never taken it.

I am concerned that it may be a big pain in the butt getting my Remicade shipped on time in the future though. Anyone else have issues with that? Do you just not get your medicine every 8 weeks then or do you have to fight with insurance to get it covered in time if they ship it too late?

omg do you have an option of a different infusion center? that is so sketch

Wow....needless to say I'm not shocked. Since that's the specific job they have, as well as the pharmacy....someone down the line should have checks in place.
Funny how it comes up just at the time of your appointment.

You did your due diligence....sucks no one else has a clue.

My first words would have been...AYFKM????

q

quincy said...
Wow....needless to say I'm not shocked. Since that's the specific job they have, as well as the pharmacy....someone down the line should have checks in place.
Funny how it comes up just at the time of your appointment.

You did your due diligence....sucks no one else has a clue.

My first words would have been...AYFKM????

q

LOL. Yeah, those were the words going through my head. Ha.

The hospital pharmacist told me Inflectra can't be called a generic because Remicade manufacturers sued them for saying so. I had not heard that before and have no idea if he's correct. I am Googling it now. I guess I would probably save a little money with Inflectra (I'd probably save a whopping $5 each infusion), but I'd rather go with Remicade since it's been around a lot longer. I actually looked into Inflectra when I was pricing Remicade and without the assistance programs, the cost wasn't that much lower for me with my insurance.

And there lies the issue. Someone told them that once....and they never made the EFFORT to give a crap whether it's true or not.
It's the same as people calling 5-ASA...ASA. NOT!

My nephew who had chemo for Hodgkins always checked with what med he was being given...one time, it was completely wrong and they said that's what the doc ordered....he replied to check his file. It was probably the doctor who made the initial mistake, but it's good he made the effort to check.

Waiting for your next appointment to hear how that one goes. 🙄

q

It is highly likely your insurance paid for the inflectra over a year ago. If you were curious you could look at your COBs from last year. I know that doesn’t really matter but if it came from biocure (then shipped to the center) and not from the center itself, then biocure got their money. If the office orders ahead and billed then no money exchanged. But since it was set aside it doesn’t sound like they do it. Unfortunately I have to call every time on my Stelara because due to new rules with my insurer they will not ship unless I have made confirmation each time. It’s because of the dollar amount. One time a tech told me I didn’t need to call back but when I told her to look at the cost she said she forgot about the rule. In pharmacy world we often call the biosimilars generic whatever even tho it’s not technically ha. Good job paying attention.

I am interested now. So does insurance send out explanation of benefits for these drugs like they do for office visits and procedures? I always look at those. Definitely never saw one for Inflectra a year ago. Never got a bill either.

As far as the billing, there can be several answers. I had meds sent to my infusion center and my insurance paid the specialty pharmacy that sent it. But, my dr changed his mind so there was never a bill from the center to infuse it, but I still paid for the drug. When I was on Entyvio, that center was actually a “location” of a pharmacy network therefore the pharmacy would send the med ahead but the cost of infusion service and the actual drug were on the same COB same provider. Again I know it doesn’t really matter but always good to watch COBs. At least you got your infusion. When I was on Remicade the nurse would show me the vials, show me the calculation and prepare it in front of my chair. I never asked them to, it was standard, but I appreciated it. I think they should all do it that way.

I am surprised they don't have you check the med every time they give it to you. When I go in, they show me the bag and have me confirm it says my name, birthdate, drug name and dosage. They also confirm that we aren't titrating and that I will get the infusion over an hour. I go every four weeks for inflectra and the infusion nurses all know me and what I get by now, but it is part of their procedure and they won't veer from it. And yes, the drug is super expensive and the pharmacy on-site doesn't mix it until you check in for your appointment, but that is no reason to try and get someone to take a med they aren't currently prescribed!

And Sara, hopefully you won't need it monthly like I do -- if it's every 8 weeks, you won't have to call Walgreens too often.

Did they weigh you before they mixed the med? They always weigh me when I check in before they mix it. Remicade is definitely weight based.

The more you talk about that place the more concerning it sounds. I hope you can find another infusion center. You might want to check out cancer doctors -- some of them have their own infusion centers in their office for patients going through chemotherapy and they also do biologic and other infusions too. Just make sure they will be covered by your insurance -- you will likely have to get it pre-authorized

You have 8 weeks before you have to deal with it again.

But what is most important ... how are you feeling? I know it's still early, but have you seen any improvement?

Sara -- that doesn't mean it isn't working, since you are still in the loading phase and you just got off of prednisone. Once you're out of loading, they may also need to adjust the dosage and the frequency. For example, inflectra was *mostly* working for me, but then at week 6, I would start seeing blood again. We upped the dosage from 5mg/kg to 10mg/kg. That didn't help, so they did a blood test at 6 weeks that showed my body metabolized the medication fast, and so by week 6 it was below therapeutic levels. We switched to every 4 weeks, and that seems to have done the trick. My GI told me that if every 4 weeks didn't work, we'd switch meds. Since you aren't on anything like azathioprine, before you are considered to have failed, it might also make sense to add that in, since people tend to do better when the two are combined.