← Return to Insurance coverage for Actemra infusion with straight Medicare?

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@linda7

Thanks to you and to others who have answered. I now am fairly confident that Medicare will cover the Tyenne ( Actemra biosimilar) infusions. The order was put in and they called me to schedule but I held off because of my doubts. I'm going to wait until my next lab draw and MD visit in about a month. That way I'll have a good baseline on the labs since the Kevzara I recently got off had caused some abnormalities.

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Replies to "Thanks to you and to others who have answered. I now am fairly confident that Medicare..."

"That way I'll have a good baseline on the labs since the Kevzara I recently got off had caused some abnormalities."
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Actemra might cause the same abnormalities. However, the dose of my Actemra infusion was easy to adjust, I'm in the low range of the normal infusion dose and I don't have the lab abnormalities that occurred with my fixed doses of my Actemra injections. I had to hold a dose or two when I did Actemra injections.

That is a huge advantage to doing infusions. My labs are monitored by my rheumatologist and he knows exactly when my infusion is done and the dose I get. My rheumatologist seems to know how long I can go between infusions. He says my inflammtion markers start to increase again when I go more than 6 weeks between infusions.

Mostly I do an infusion every 4 weeks but I feel like it can be stretched to 6 weeks. My rheumatologist says not more than 6 weeks between infusions.

I am currently on Tyenne and tapering off Prednisone. I was given the choice by my Dr. to either come in once a month for an infusion or do a weekly injection myself. My copay through my insurance (not medicare) is $30.00 a month. I have had NO side effects with Tyenne and it has been working wonders for me. I wasn't able to get below 30mg of Pred without pain. I am starting my 3rd month of Tyenne and I'm down to 17.5 mg and Friday I will drop to 15mg. My Dr had me go 30,25,20,17.5 every 2 weeks. Good Luck & hope it works for you!