Kevzara and Prednisone Tapering before and during Kevzara

I have been on Kevzara since Oct. 2023. I have tapered very slowly as I have relapsed before. When I started Kevzara, I was on Prednisone 10mg and Methotrexate 17.5 mg. I am currently down to 3 mg of Prednisone and 7.5mg of Metho. The Kevzara has really made a difference but now I’m challenged with the price of it. I have Kevzara co-pay card and Optum RX insurance, but in December they charged me personally almost $1600 for the 2 doses. I am going round and round with both companies. I may not be able to take it anymore do to the cost. What a bummer. Just when you start feeling good again:-(. Has anyone else had trouble with the co-pay card or any advice? Thank you.

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.

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.

I have been on Kevzara since Oct. 2023. I have tapered very slowly as I have relapsed before. When I started Kevzara, I was on Prednisone 10mg and Methotrexate 17.5 mg. I am currently down to 3 mg of Prednisone and 7.5mg of Metho. The Kevzara has really made a difference but now I’m challenged with the price of it. I have Kevzara co-pay card and Optum RX insurance, but in December they charged me personally almost $1600 for the 2 doses. I am going round and round with both companies. I may not be able to take it anymore do to the cost. What a bummer. Just when you start feeling good again:-(. Has anyone else had trouble with the co-pay card or any advice? Thank you.

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.

I am about to start Kevzara but would not have been able to since the cost to me would have been close to $2k every 28 days. I applied for patient assistance through the drug company and will be receiving the med at no cost to me. I am on Medicare and a good supplemental plan but the coverage was not good enough to pay for all of it. The process is fairly simple and it’s done through their website. I hope this helps you and that you are able to stay with the treatment especially since it seems to be working for you.

I have taken prednisone and methotrexate for 2.5 years and my disease appears to be chronic. My rheumatologist has mentioned Kevzara as an option and I am tired of the side effects of my present drugs. I am on Medicare A, B and D ( Aetna Silverscript for the D). I went on Medicare.gov and entered Kevzara as a medication that I take. Their calculation recommended staying on Silverscript and the monthly cost for Kevzara would be $280. Has anyone found a way to reduce this cost? The drug company offers co-pay assistance but I am not sure if people on straight Medicare and part D are eligible. Kevzara is not available as an infusion which would have better coverage.

Just be careful-I assume you have the copay card? They pd for mine Oct, Nov, Jan but not December. I owe my pharmacy $1600. I am working with both but may I suggest to you that you call Kevzara monthly to check on your status so you don’t end up with a large bill like I have for reasons unknown. They are working on it.