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Insurance coverage for Actemra infusion with straight Medicare?
Polymyalgia Rheumatica (PMR) | Last Active: 21 hours ago | Replies (25)Comment receiving replies
Very unusual that your doctors office comments like this. They want you for a patient, they want to treat you, they want to get paid or reimbursed for their services and yet they don’t assist with a pharmacy consult to see if the drug interacts with anything you are taking and in the pharmacy consult they can tell you what insurance covers your copay etc etc. ask for a pharmacy consult specific to rheumatoid issues if possible. My rheumatologist does this with every new medication I try. Part of the serve and there should be no charge for this.
Replies to "Very unusual that your doctors office comments like this. They want you for a patient, they..."
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Thanks for your comment. I agree that my doctor's office was not very helpful in figuring out payment issues. The billing people did tell me that they would bill Medicare for the whole amount of the infusion and not part D. I had a problem with my private profit-based part D insurance not covering Kevzara. I have been healthy at age 75 up until PMR and am still learning the Medicare (straight Medicare not Advantage) system as a patient. I've never had an infusion so don't know if a pharmacist gets involved. I'm glad I held off on starting the infusion. The comments here and my research have helped me to formulate questions to ask my doctor at the next visit before I make a final decision on the Tyenne ( biosimilar Actemra).