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New Dx of PMR

Polymyalgia Rheumatica (PMR) | Last Active: 2 days ago | Replies (30)

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@rnm

Thank you for sharing this info...
Do you wish that you had started on Kevzara?
Also, one of the members of this group seemed to imply that if Kevzara was injected at a hospital rather than self injected, that it would be covered by insurance.

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Replies to "Thank you for sharing this info... Do you wish that you had started on Kevzara? Also,..."

Regarding whether Kevzara would be covered by insurance if it was injected at a hospital, I can speak to that a little based on my experience with Actemra. I have a Medicare Advantage plan. When I was discussing Actemra last year with my doctor, he said that it is available through infusions or injections. My understanding is that the infusions would be covered by Medicare Part B, and the injections (which are done by the patient at home) would be covered by Medicare Part D. For me the Actemra either by infusion or injection had to be pre-approved by the insurance company. They approved weekly injections for me. I think in most cases the copays are higher for drugs covered by Medicare Part D than the ones covered by Part B. Last year the maximum out of pocket cost for prescriptions under Part D was $8000, and this year it is $2000. I assume Kevzara is similar to Actemra in regard to insurance.