Remicade and lab test AnserIFX

[CJMom]

My son has been on Remicade, for less than a year. They recently increase the dose as he was not lasing the 8 weeks. He now is going every 6 weeks with the higher dose. They started him at the lowest dose initially and did show improvement and even gained 10 lbs. He now has severe stomach pain, but no constipation, which is how it usually presents with him. They sent him for more blood work and are also ordering a blood test called Anser IFX, which is considered experimental and not covered by insurance. Insurance will cover Remicade but not cover a test that looks at the serum level as well as to check the antibodies. Go figure!

Has anyone else had their child have this test as well? My son is 13 and the started him right away on Remicade due to his age as well as he had a bad anal fustula as well. What is the goal of this test and why don't insurance companies cover if it helps to determine if the medicine works. They authorized and paid for the medicine, but not the test.

So frustrating and heart breaking, everything about this disease and then all the hoops you have to jump through with insurance and ever doctors.

 

[Jmrogers4]

I think you can argue for it to be paid and if it is denied so many times the company that runs the test pays for a majority of it or something similar. I think crohnsinct has had to do that she is probably typing an answer as I type this if not she'll be along soon

 

[crohnsinct]

Yes. We have had that test done a number of times. It looks to see if the patient is building antibodies and if that is the reason for lack of response but also looks at the levels of the drug in the system. Since the drug is metabolized by each patient at a different rate, lack of response could also be due to the patient burning through the drug too quickly. My daughter has been as quick as every 4 weeks and at 11-12mg/kg. As the body heals, it burns up the drug more slowly and she is now at every 7 weeks and 6mg/kg.

There is also evidence that a constant level of about 4 will increase the amount of time the patient stays in remission with the drug.

Insurance companies would prefer that docs treat by symptoms. So increase dose or shorten interval if the patient is experiencing symptoms. However, that leaves the person who is building antibodies on a useless drug and unprotected for months before the doc can finally figure that it is an antibody issue. You really want the test so you have a clear picture of how to proceed with treatment. I am glad you approved the testing.

Prometheus charges $2,500 for the first test and $350 for subsequent tests (my daughter had them frequently at the beginning). There is a long thread here explaining all the ins and outs of the testing and coverage but basically, Prometheus will charge your insurance. If they deny the bill, Prometheus will appeal the decision on your behalf (you just have to sign authorization paperwork, which they send to you). They will appeal until all appeals have been exhausted. If the final decision is denial, Prometheus will write down the bill to $250 for you. I am not quite sure about the subsequent testing because we haven't gotten through that appeal process yet.

The curious thing is...before Prometheus brought all the testing in house, our testing was done by another lab and it was always covered and never cost thousands of dollars. Then one day Prometheus was the only lab that did the testing and the cost sky rocketed. There are now other labs that charge around $500 but I understand the results aren't necessarily as good. Plus you still risk the denial and I don't know how much the other labs will write off.

Good Luck.

 

[crohnsinct]

I think crohnsinct has had to do that she is probably typing an answer as I type this if not she'll be along soon

:rof::rof::rof: OMGOSH! I WAS! Jinx you owe me a beer :drink: