Straight Medicare will cover Actemra infusions because they are given in a "hospital setting" and are considered to be "inpatient medications" instead of "outpatient medications." The problem is that Actemra isn't FDA approved to treat PMR. I was in the same boat because I was never diagnosed with GCA ... only PMR. My rheumatologist had to make a strong case for wanting me to have Actemra infusions and he managed to get it approved.

There have been people here with "presumptive GCA" but I think their doctor still had to get Actemra infusions authorized. I don't think the patient can do it and some doctors aren't willing to make the case for Actemra infusions.