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Notice from Insurance about Switching from Remicade to Biosimilar

Hey everybody. So today in the mail, I got a notice from my insurance that says that beginning February 1 next year, they are going to switch my Remicade to a biosimilar. I am very hesitant to switch since I have done so well on Remicade. They stated that unless there is approval by my doctor to stay on Remicade, they're going to switch me to a biosimilar. My concern from what I have read is that if I switch to a biosimilar and it isn't as effective as Remicade, I won't be necessarily able to switch back to Remicade due to antibody formation. Should I reach out to my doctor about this? Any insight is appreciated. Thanks!
 
Hi @awoenker12. It won't hurt to reach out to your doctor. This is also happening in a couple provinces in Canada. I have done some research, and it appears many don't notice any difference when switching. I understand though how you feel as my son is on Remicade and I also would feel the same way if they were to switch it to a biosimilar. Talk to your doctor at least, but I don't think they would be making these changes for people if biosimilars weren't effective. Glad you are doing well!
 

my little penguin

Moderator
Staff member
Talk to your Gi - Gi would need to prove ira medically necessary to insurance for you to stay on remicade. But definitely have the conversation
 

Lady Organic

Moderator
Staff member
I agree. When this is going to happen with Humira, I am going to ask my GI to remain on it, no substitute. I have heard research so far as shown there are no issues switching, but all of this is so early to know fully in the long run. It can often take a year or more for a relapse in IBD after a prolonged remission under treatment. Moreover, loss of response over time to any medication is common. I for one really prefer not to play with any variable involved in a treatment that works for me. I have had enough of that one bad experience after changing a medical plan 10 years ago that from now on, when something works, I wont play or modify it, unless I am forced to do it.
 
I got the same notice from my insurance last month, and I already had a documented history of the biosimilar not working for me.

Three years ago, after being on Remicade for about four years, I tried the biosimilar for six months right when it was made widely available, and it wasn't effective. In fact, it caused a flare and it took me a year to get Crohn's back in remission. My doctor wrote a note to the insurance company at that time and they approved Remicade for me since the biosimilar didn't work. I had no trouble switching back to Remicade as far as my gut was concerned. It did take about three infusions to build up to the level where it was effective for me and I got back into remission.

So when I got the most recent letter in December of 2020 about my insurance again kicking me off Remicade, I asked me doctor to write another note to the insurer, which she did, and, once again, I got special permission to be on Remicade due to my history. My insurance will cover Remicade for 2021, and then I'll have to have another note written each year to get the waiver. (This is how my doctor gets to spend her time.)

If you have never tried the biosimilar, you might need to go on it for a while and maybe it will work just as well as Remicade. I wish it had worked for me! It is effective for many people and maybe you'll get lucky.

Before I was allowed to try Remicade, I had to jump through hoops with several other medications that didn't work for me, just to please the insurance company. I've had to live through a lot of flares thanks to the insurance industry wanting to overrule doctors with prescriptions.
 
My insurance did that to everyone about a year ago. I haven't noticed much difference.
But my iron stores were low, so last month was iron infusions and the past 9 days has been a flare up. Liquids only today and it's the best I've felt in a week.
So maybe they're not the same and the brain fog kept me from noticing?
I hope it works out well for you, whatever happens.
 
Oh, so sorry to hear that, Paddywack! My decline on the biosimilar, Renflexis, was over a six-month period, so it you've been on it a year, maybe this is just a fluke. I hope you get back in remission feel better soon but, if you don't, maybe your doctor will want to change you back to Remicade, too.

I just had my first Remicade infusion of the new year so everything seems fine, but I will have to get permission to stay on it every year.
 
Oh, so sorry to hear that, Paddywack! My decline on the biosimilar, Renflexis, was over a six-month period, so it you've been on it a year, maybe this is just a fluke. I hope you get back in remission feel better soon but, if you don't, maybe your doctor will want to change you back to Remicade, too.

I just had my first Remicade infusion of the new year so everything seems fine, but I will have to get permission to stay on it every year.
I had my infusion this past Tuesday. I don't know if it's related or not, but I suspect I've got a touch of pancreatitis going on. SMH. It never ends.
 
My insurance says no to a lot of my meds... My doctor tries to fight for me but it doesn't always work... If are insurance company are so smart then why do we need doctors? I suffer so much unnecessarily because of insurance. Not right...
 
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