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Rheum wants Kevzara but Methotrexate much cheaper, work as well?
Appreciate any input. I'm newly diagnosed 7/31/26. Started at 15mg, had to go to 20mg, then to 25mg for 2 weeks to get all pain and symptoms under control. Saw my Rheumatologist today, 1st follow-up. I tapered to 22.5mg 7 days ago. She's concerned re flares for me because I had to step up twice just to get under control initially. She wants me to start Kevzara to help me taper over time, hopefully without flares. The Kevzara & Methotrexate both require prior authorization to even get covered by my insurance. Kevzara shows 4,000.00+ price without insurance, while Methotrexate shows 200.00+without insurance. It's a no brainer for me as I've had way too much health expenses already this year. Anyone have experience they can relate about Kevzara, any side effects, or Methotrexate and any side effects? Or any other drug that can help bridge the Prednisone tapers? I appreciate any help at all. Thank you all.
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@jeff97
I'm sorry to hear you're dealing with both. I hope the Acetmra is helping you to feel at least OK and keep them under control. I've read that anyone can get GCA after PMR diagnosis even if don't have it initially.
I don't know a lot about it but know it's very serious. Blessings and protection. Thank you again for your help.
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2 Reactions@boomermeg
The manufacturer copay card covers private insurance, not government issued insurance. I'm not sure how that works with the Medicare advantage plans, but you can go to the manufacturer website for answers.
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3 Reactions@kjoed53
Thank you for this information. I'll check the Mfg. website.
It'll be good to know if the discount applies to Medicare Advantage plans or not. I appreciate it. Blessings.
@boomermeg Alas, I checked this out, and the Medical AI says Medicare Advantage plans are excluded from the discount referenced on the manufacturer's website.
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1 Reaction@p0rtia
Thanks for doing that. I had just spoken to my ins who looked at the Kevzara site and that's what she thought.
Any government provided ins is out.
Thanks for letting me know. We'll see because my ins said Tier 4 is 41% of cost (my copay). That's going to be way too high if the total cost is 4700.00+ for 28 days.
We'll see. Blessings.
@boomermeg I'm confused. Your tier 4 drug is still covered under Part D, isn't it? So your maximum out-of-pocket for Part D drugs this year is $2100. My Actemra is Tier 5, specialty, and it's covered under Part D because it is an injection I take at home.
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1 Reaction@jeff97
Hi Jeff97. I still won't know the bottom line until the prior authorization and price to me comes through afterwards. The Humana lady in "RXs" said my cost is 41% of the price, but she was quoting me the cost that was showing on the website that's "without insurance."
So, I'm still not sure if the 41% of 4700.+ is actually correct. Yes, I have a 2100.00 total deductible for this year, with about 1200.00 remaining so it'd be about 300.00mo/each for Sept,Oct,Nov,December this year, if that's correct total cost.
I just realized what you told me about next year. 2100 or 2200 max deductible paid out, then I'm in catastrophic coverage and won't pay anymore for any drugs the rest of the year. So, you're right!!
I'll try to keep it straight....lol
Thanks again for all your help! I need all I can get. Blessings again.
@boomermeg The out-of-pocket costs have improved a lot since I was diagnosed a little over 2 years ago. I started taking Actemra in August 2024. 2024 was the last year of the notorious Medicare "donut hole", where catastrophic coverage started when you had paid $8000 out of pocket. I started Actemra in August, so I didn't make it to $8000, but I came close enough. I thought it was great when the out-of-pocket make for 2025 was $2000.