'Insurance coverage for dummies' - I need this
We had Medicare and federal bcbs for a long time and it just got too costly so we switched to a federal Medicare advantage plan which has worked well and saving money. I have several prescriptions all with minimal copays. It appears a biologic will cost $350/month until I reach $2000 for the year. Kevzara is injection only so there is no getting around the cost with an infusion instead. In researching Aetna Actemra coverage, it appears that it can be approved for pmr if you can meet one of their requirements which could be difficulty tapering prednisone - that's me. However, I don't see Actemra infusion in the formulary - only injections. That's as far as I researched. I didn't think you could get Actemra with a pmr diagnosis but it looks like a possibility.
I am at 3 mg prednisone, going to wait a couple months before trying to taper lower again.
Do I think I could get Actemra infusion covered with no copay? I don't know. It's a 'rabbit hole'.