Rheum wants Kevzara but Methotrexate much cheaper, work as well?

@boomermeg "I'm 73 with sleep apnea, chronic pain and breast cancer (had lumpectomy)" Sister!!!

I have been on prednisone for 8 years and could never get below 5 mg and always hovered around 8 mg as the most effective zone. I tried MTX for 10 months and I must say that it was the worse 10 months for me. I experienced so much fatigue. I had to rest between doing 30 minute jobs around the house. Also, I would eat small amounts and always feel nauseous or have an upset stomach within 90 minutes. Then I started getting the metal taste in my mouth. To top it all off, I never got below 5 mg of prednisone.
I have been on Kevzara for 2 months. Have my energy back. No nausea. Metal taste is just about gone. I sleep well. I reduced to 5 mg of Prednisone and by going slowly hope to continue downward. I have been reducing by 1/2 mg per week. I’ll probably stay at 5 mg for a few weeks as that’s a crucial number when reducing. I feel like my old self again.
Good luck with your drug journey.

@lynnfromoro
Thanks for sharing your experience with me. I'm sorry you've been on Prednisone so long and that your experience with Methotrexate was so bad. I feel that it'd probably be very similar for myself. I have sleep apnea and use C-PAP, and have chronic pain so they already can make me tired, and then the PMR on top. Then the nausea would be a big problem too. I would like to have Kevzara as a possibility, but I'm pretty sure it's going to be far too expensive for me. I have a Medicare Advantage insurance plan but it's not on formulary and requires prior authorization. If you have no insurance it's over $4,000.00 a month! So even if they cover it, and I have a copay, it'll probably be close to at least $1,000.00 a month. I'm not positive, but I can't see them paying too much of the cost. If they do, that'd be great, but will have to see. Somehow, money always becomes a barrier for people with RXs that can be life altering or life saving. We wouldn't qualify for help from the Manufacturer so that wouldn't work either.
Thank you again for sharing your story with me. It gives me hope. May you continue to taper and become Prednisone free after all these years. Blessings to you.

I have been on prednisone for 8 years and could never get below 5 mg and always hovered around 8 mg as the most effective zone. I tried MTX for 10 months and I must say that it was the worse 10 months for me. I experienced so much fatigue. I had to rest between doing 30 minute jobs around the house. Also, I would eat small amounts and always feel nauseous or have an upset stomach within 90 minutes. Then I started getting the metal taste in my mouth. To top it all off, I never got below 5 mg of prednisone.
I have been on Kevzara for 2 months. Have my energy back. No nausea. Metal taste is just about gone. I sleep well. I reduced to 5 mg of Prednisone and by going slowly hope to continue downward. I have been reducing by 1/2 mg per week. I’ll probably stay at 5 mg for a few weeks as that’s a crucial number when reducing. I feel like my old self again.
Good luck with your drug journey.

@boomermeg I have a Medicare Advantage plan, and I take Actemra. I'm currently taking 2 injections per month, but I took 4 injections per month for 2 years. I get a monthly report online and also through the mail about my drug costs. Here are the numbers for a month where I was taking 4 injections:

Drug price charged by the specialty pharmacy: $4876
Discount from manufacturer: 975
Amount pain by insurance: 3901

Because I am taking injections, the Actemra is covered by Part D. There is a maximum of $2100 out-of-pocket for Part D medications for 2026. I think the maximum will be $2200 in 2027. I paid the full $2100 with my first refill this year, but I think you can set it up so that the copay is evenly distributed over the year. For this year, that would be $175 per month, and next year $183 per month. If you started taking Kevzara now, in September, you would have to pay the full $2100 in 4 months, so that would be more. That assumes you haven't already paid part of the $2100 for other prescriptions. Then in January, you could start paying the $183 per month if you set it up that way. For me, paying the full out-of-pocket copay at the start of the year is a big hit, but from then on all of my medications for the rest of the year are no cost to me.

@jeff97
This is so helpful Jeff, thank you so much. I too have a Medicare Advantage (Humana PPO). It's $2,100.00 max (before catastrophic) for Part D meds this year also. I still have a ways to go on my 2,100.00, but they haven't billed some of my iron infusions yet, so it will get closer.
Could I ask you how does the Manufacturer give this $975.00 discount, and did you use a specific specialty pharmacy that gives a better price? If you have to qualify for Manufacturer discount, we probably won't. I really appreciate you're help. Thank you so much. Blessings.

@boomermeg My insurance (BC BS of NC) only has a couple of specialty pharmacies in network, so my rheumatologist sent my prescription to one of them, Accredo, which is based in Tennessee. I don't know how the manufacturer discount works. I didn't have anything to do with it. I would think that the insurance company negotiated the discount, but that's just a guess. Actemra has competition now from some other biosimilars like Tyenne, so maybe that's why the manufacturer has the discount. I have a friend that has a Humana policy and takes Actemra injections, but I don't know any details about what Humana pays for it. I know from my friend that Humana has their own specialty pharmacy.

@jeff97
Thank you for this info too. It'll all help me to navigate the"sparing" RX situation. I think I saw one speciality pharmacy come up on the Humana website (near me). Thank you again for all your help. It's very much appreciated.
Blessings and prayers for your PMR.