Remicade $$ Vent

[Mehita]

Just needed to vent on the cost of Remicade in the US. When my son started two and a half years ago, the entire clinic trip, including nurse time, labs, etc was about $3000, most of which our insurance thankfully covers.

I was just looking at his EOB from his last infusion (putting together our Remistart paperwork) and the entire clinic trip is $18,000 prior to insurance. Whoa!!

Now, his dose did double in the last year due to him growing and needing more in his system, but nothing else has changed. Same nurses, same labs, same chair even!

I know there was talk at one time of a generic coming out, but haven't seen anything lately. Does anyone know?

Thank goodness my family is blessed with good jobs and health insurance covers most of this. I'm just blown away with how much this costs.

 

[Clash]

I know Inflectra has come out as a biosimilars for remicade in some countries. But some of those countries haven't approved them for pediatric use. I think the biosimilars is still going through FDA process here (or maybe humira's biosimilar) but I think it's in the final stages of approval.

 

[FrozenGirl]

I'm in Canada and we have Inflectra, what they call a "bio similar". I have been told it is 20% cheaper than Remi.

However it is not approved for pediatric or (more interestingly) Crohns or UC. Health Canada approved it for all the other indications (RA,PA, Jspa etc). They said (basically, I can dig up the exact wording if anyone wants), there is a small difference in Remi and inflectra and they can't be sure that difference isn't the thing that works for IBD.

I also know thy have one called Resima I think it is in other places (no clue where).

 

[FrozenGirl]

Also wow 3000 was a good price depending on dosage. It was just over that for 3 vials for me. Just the drug, because we don't pay for nursing care,labs etc. Obviously the US negotiated lower drug prices at least at the start.

 

[Rez]

Hi all, how do you all afford this? My daughter is going to be placed on remicade if the insurance approves it. I do not think I will be able to afford the copay. I tried calling the insurance company to find out what my copay would be but they close at 4. Ugggggh

 

[Clash]

For remicade there is a co-pay assistance program offered by the manufacturer. It is not financially based so your salary is not taken into consideration. It requires that you have commercial insurance which it seems you have. The name of the program is REMISTART and can lower your out of pocket cost to 5 dollars per infusion.

When my son was on remicade I think we paid 248.00 out of pocket for the entire year.

You can Google REMISTART to get to the site and the application is on there. You can also go through your GI to get enrolled.

 

[Rez]

Awesome, Thank you for the quick response.

 

[SciFiGuy]

Depending on your insurance plan it can cost a lot or a little - my last job I was on the high deductible, and in the first year of treatment, the first dose of the year was always a ridiculous amount: it started at $1200 (then $200-$240 the rest of the year), and just before I switched jobs, it was $2000 (then $300-$350 the rest of the year). Ever since I switched jobs & switched my insurance plan to in-network only (I checked all of my doctors and they were literally all in-network, so I had no reason not to), I haven't had to pay a dime on it since. Aside from this awful hiccup I've recently had where they needed to re-authorize the Remicade, this has (to-date) been the best experience I've had with any health insurance company. I don't know if you can go in-network or if it's even close to the same situation, but it helped me save a ridiculous amount of money per year.

 

[Rez]

Great information. Thank you.

 

[Clash]

That's true without REMISTART it can get a bit high. The amounts(without REMISTART) can vary depending on your insurance deductibles and such. But, since REMISTART isn't financially based there's no reason not to enroll.

There is the exclusion of Medicare/Medicaid meaning it needs to be commercial insurance not government funded. If you happen to have government funded still check out the site because there maybe help for that type as well.

 

[aypues]

I've decided that Remistart is almost worthless. It only covers the first $20,000 in drug costs, and it doesn't cover the infusion center fees. I get the regular 5mg/kg and the drug only bill is 9k. That means that I will have burned through the Remistart copay assistance after about 2 infusions. If I was on 10 mg/kg I would burn through it in 1 infusion! My copay is $250 on biologics, so it would save me $245 for about 2 infusions, then after that it's done, and I have to cover the infusion center junk fees anyway. Next year I am getting a Platinum plan (no employer insurance) so my out of pocket max is lowered to 4k, with no deductible.

 

[Clash]

Do the co-pays work toward your deductible? We don't have Co pays so I wasn't sure how that worked. Our insurance pays 80/20 until deductible of 500 individual or 900 family is met then 90/10 up until out of pocket max is met which isb1500.00 (but includes deductible) then 100%. So until we hit insurance paying 100% REMISTART paid the out of pocket part plus it is counted toward our out of pocket. Since the remicade infusions were at the GIs IV lab in office I guess the fees were negligible.

 

[aypues]

Do the co-pays work toward your deductible? We don't have Co pays so I wasn't sure how that worked. Our insurance pays 80/20 until deductible of 500 individual or 900 family is met then 90/10 up until out of pocket max is met which isb1500.00 (but includes deductible) then 100%. So until we hit insurance paying 100% REMISTART paid the out of pocket part plus it is counted toward our out of pocket. Since the remicade infusions were at the GIs IV lab in office I guess the fees were negligible.

no, the deductible means you pay 100% until you reach the set deductible dollar amount, and then insurance kicks in at whatever level you have. Luckily, I have no deductible so insurance starts paying right away. I am left with 20% copays on my gold plan, but next year will probably opt for a Platinum plan which is only 10% copay on medical procedures, with a max out of pocket of $4000 annually which is great. after you reach the 4k then insurance pays 100% instead of 90%. btw, your insurance premiums don't count toward your out of pocket expenses.

Your insurance sounds great! only $1500 out of pocket max.

 

[Clash]

You are right I don't know where I was getting the 80/20 from. It's 500 individual deductible or 900 family. Once that's met it's 90/10 until 1500 out of pocket is met (but deductible is included in that 1500.00 max)

But when we were on REMISTART everything they paid after insurance went toward our out of pocket max. That may have changed, it's been a couple years since we were on remicade. My little penguin was it this way when you guys were on REMISTART?

Our out of pocket is going up. It has gone up every year. I think the next increment is 2000.00. Our deductible has gone up each year as well for the last 4 or 5 years but in smaller increments. In fact, I was blown away by my husband's health care when we first got married 7 years ago! He had no premium (it remained that way the first 3 years) at that time our deductible was like 300 and the out of pocket max like 900. I'd never seen such good insurance! It started going up like a year before ACA came into law but I still think it's a great plan but our premium is now 206 per month but that is a family of four so still really good.

 

[aypues]

omg. 206 per month. that is like Cadillac health plan. keep that as long as you can. I pay 420/mo for a gold 80/20 plan (no deductible) for a single person, 38 year old!!!

 

[Clash]

Yeah I know, I dread when my son, with CD, ages out and has to come off our plan. I think it's going to be a bit of sticker shock for him as it isn't something that is in the forefront of his mind since he doesn't pay it out.

 

[Layla]

I really feel for all you Americans and your health system every time I read threads like this!
I've lived in several countries and wouldn't even consider living in one without a public health system. I've just switched from Humira to Remicade and it costs me nothing, nada, zip, zilch. When I was on Humira it cost me $5 every 3 months as that is the charge for the pharmacy. Even that maxes out at 20 prescriptions per year so never more than $100 a year.

Having said that I do still have private health insurance on top of the public system which is quite pricey at $440 a month, that's about US $315, but that gets me off waiting lists for colonoscopies, MRE's etc and it paid for my resection in a private hospital, most likely by the same surgeon who would have done it in the public system
as most work in both systems.
Most people don't have private insurance and in reality I don't need it but I can so I do, for the time being.
We probably pay more tax here but I've always been happy to do that because I value public health among other things.

I really hope Obamacare, or whatever the American version of public health insurance is called, takes off and levels the playing field somewhat and makes it possible for normal people to get the care they need regardless of their financial circumstances!