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Actemra coverage on Medicare in California?

Polymyalgia Rheumatica (PMR) | Last Active: Sep 23 8:24am | Replies (28)
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@redboat

Thanks @jlo2252 ! Assuming Kaiser Senior Advantage in Southern California is like Northern California's, Actemra should be covered. In NorCal, Medicare Part D coverage, which is needed to offset costs for Actemra, is included at no extra cost at Kaiser. There is a new alternative, called Tyenne, which I understand less expensive. But Tyenne and Actemra are both quite expensive. Without insurance or any offsets, Actemra is something like $40,000/year.

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Replies to "Thanks @jlo2252 ! Assuming Kaiser Senior Advantage in Southern California is like Northern California's, Actemra should..."
jlo2252 | @jlo2252 | Sep 15 1:21am

@redboat
So I just found the handbook Kaiser sent me of my evidence of coverage(EOC):
Kaiser Permanente Senior Advantage (HMO) with Part D
They deduct $174/ month from my social security for my Medicare. My yearly out of pocket expense is $1000.
And yes they do cover biologics, injection or infusion at no charge. Don’t know if this is normal coverage for everyone. Like I said I had kaiser employee negotiated benefits and when I retired my benefits didn’t change from when I was working and they were good.

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jlo2252 | @jlo2252 | Sep 15 5:14am

@redboar,
It’s nice to talk with someone who also has Kaiser insurance!
I cannot believe how expensive the biologics are! My daughter had kaiser thru her job, her coverage was quite different then mine. She has Crohn’s disease that she takes a biologic (Remicade) for. Normal cost is around $12,000 per infusion! Out of pocket she paid $200 per infusion! But it helped her a lot, so what choice does she have ?

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