← Return to Kevzara and Prednisone Tapering before and during Kevzara

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@dadcue

All biologics are expensive and the cost of Kevzara is no different.

There is a loophole for biologics given by infusion for people on Medicare. As long as the biologic is FDA approved for the condition being treated, Medicare will pay 80% of the cost to do an infusion. A good Medicare supplement will pay the remaining 20%.

"Injectable and infused drugs: Medicare covers most injectable and infused drugs when a licensed medical provider gives them, because these types of drugs aren't usually self-administered."
https://www.medicare.gov/coverage/prescription-drugs-outpatient
An injectable biologic usually isn't covered because it isn't "medically necessary" for a licensed medical provider to administer them. However, an infusion needs a nurse or someone who is qualified to start an IV and give the medication.

Unfortunately, I don't think Kevzara is available by infusion. For people with GCA however, Actemra can be given by infusion.

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Replies to "All biologics are expensive and the cost of Kevzara is no different. There is a loophole..."

Darcie, it is just wrong that because Kevzara is self administered as opposed to an infusion that D England and others are being held up by these 3d party plan managers. I would think that not having a provider administer a drug and not have to pay for an office visit would be a no brainer for the insurance companies.