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Remicade insurance for an international student moving to US

Hi,
I’m Callum and I’m 17. I’m looking to move to California and study for a bachelor's degree. Here in the uk, I’m covered under the NHS so everything is free, however, I know how expensive it can get in the states. What’s the best/cheapest insurance plan? I contacted my college to see what their insurance plan covered and it only covers 50% of the cost up to $250
Kind regards,
 
Hi Callum - I don't live in the USA but did you try contacting the makers of Remicade? In Canada, they will cover part or sometimes all of the cost. Jenson is the maker of this product. My son is on remicade and we were assigned a coordinator who works for the pharmaceutical companay. Not sure if the USA has the same set up. I am tagging @crohnsinct who lives in California and has daughters with crohn's. She definitely would have some helpful information for you. Good luck to you.
 

my little penguin

Moderator
Staff member
In the US insurance covers most of the cost of remicade - you cover the copay which can be in the thousands of dollars - the drug company has copay assistance meaning they help you woth what you owe for the copay and leave you woth a cost of $5-$50 dollars
But
The big but is your insurance has to cover the rest of the costs of the infusion /extra medical charges and drug remicade as part of the coverage .
Preexisting conditions such as crohns are harder to get covered if you are not a US citizen

10 years ago the cost of remicade plus infusion was $10,000 dollars so only covering up to $250 isn’t going to help much

maybe @crohnsinct might have more ideas

contacting remicade drug makers may also help
Maybe but worth a call /email
 
First it's important to know that here in the U.S. the pharmaceutical industry overcharges terribly and plays an giant shell game with insurance companies. My Remicade infusions cost $26,000 per dose. Because of the high price, many patients here decide not to take Remicade because it's too expensive, so Remicade started a program where they the patient's portion just so they can collect from the patient's insurance company. Otherwise they get would $0.

In the US, this program (Janssen CarePath) will pay all but $5 of the patient's share, but only IF you have private insurance. So figuring out your insurance provider here in the U.S. will be key. You may pay more for private insurance but it will ultimately cost much less over 4 years of infusions.

I would first figure out what hospital you would get your infusions in in California. If there's a university hospital in your new city, that would probably be your best bet. Then contact them and ask for a referral to a social worker or someone in patient services. Tell them you need to talk to someone who handles patients getting Remicade infusions.

Also, in terms of what your student health plan representative told you, that doesn't sound right to me. Make sure the $250 is total coverage. It might be the out-of-pocket amount, meaning once you have reached $250, you don't have to pay anything anymore. For example, my insurance company's private insurance has a $1,500 out-of-pocket charge, and I pay a certain percentage of medical costs (called a co-pay) until then. Before I got Janssen CarePath, my co-pay per infusion was $800, and I reached the out-of-pocket cost after the second dose, so everything was free after that for the rest of the year. The out-of-pocket cost also applies to all other medical costs for the rest of the year,not just Remicade.

The other thing you have to find out is if the student health service is connected with private insurance. If it's public, you can't get the almost-free Remicade. There are private insurance companies in the U.S. that specialize in policies for college students.

If you can't get insurance without putting out a lot of money, Callum, it might be cheaper for you to fly home for your infusions. If you timed it right and got an infusion just before leaving the U.K. and scheduled another appointment for right after the end of the spring semester, your flights home during the academic year would be cheaper than a single infusion. I don't know how often you get your infusions, but perhaps your doctor can adjust it to a higher dose less frequently. For example, I tolerate Remicade well and get a high dose once every two months.

Hope that helps. Welcome to American health care!
 
I think it would be wise to contact Remicade. Your college will cover 50% of the drug cost for you. There is a good chance that the remaining 50% or part will be taken over by the company itself. You can also visit https://www.remedigap.com/medicare-supplements/medicare-plan-n-vs-plan-g/ for more information on health insurance plans. You may be able to find the right plan for you. In any case, you can explore all the options and choose the most suitable one. I wish you good luck with this. I hope this does not prevent you from getting a bachelor's degree in America.
 
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