All of this is interesting. I started with Actemra injections about 6 years ago but I needed a waiver by the hospital to get it approved. I think there was some compassion involved because I only needed to pay a small amount for the injections. My injections were never submitted to Medicare but I only paid a small copay.

Over time, I was switched to monthly Actemra infusions. This was mostly because it was believed that infusions might work better than the injections. Now my infusions are submitted to my Medicare supplement but not Medicare itself. I don't pay anything for "inpatient infusions" even though I'm technically only in the hospital infusion area for 2 hours once every month. The hospital gets a sizable reimbursement from my Medicare supplement.

When I started Actemra --- Kevzara for PMR wasn't on anyone's radar. I think the success of Actemra to treat GCA opened up new options instead of lifelong Prednisone in my case.

I honestly don't know how my Actemra gets paid for. "Presumptive GCA" was part of it. Another part was "let's see if Actemra works if I was willing to try it" on the part of my rheumatologist. I was nearly unwilling to try it when people who didn't know anything about Actemra said it might be worse than Prednisone. Clearly ... Actemra has not been worse for me at least.

It is a shame that so much about medical treatments boil down to who is going to pay for it. Then it seems to hinge on creative reimbursement scenarios so everyone stays happy.