1. < Polymyalgia Rheumatica (PMR)
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Rheum wants Kevzara but Methotrexate much cheaper, work as well?

Posted by boomermeg @boomermeg, 5 days ago

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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p0rtia | @p0rtia | 17 hours ago
In reply to @boomermeg "@jeff97 Hi Jeff97. I still won't know the bottom line until the prior authorization and price..." + (show)
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@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.

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@boomermeg I have my 3 month appt with my rheumy in 10 days. I will report my lowest effective dose and plan to push hard for Kevzara, to get the ball rolling. I want to know my options. I'm on UHC Advantage, and I want to find out as early as possible what the cost will be. I've also spoken with the wonderful folks as my Specialty Pharmacy, and they are optimistic that they can get a discount. But I'm not counting on that. I'm hoping I'll end up in the "pay the 2k+ to max out your cap for the year" pool. I'm aiming at early 2027 to start, so I get the most bang for my bucks.

I admit I'm concerned that the above will be negatively affected in 2027 by the changing insurance climate.

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boomermeg | @boomermeg | 15 hours ago

I hope you'll be able to get Kevzara too. I've thought about waiting until Jan as well, but will have to see what my Rheumatologist says and how I'm doing as I taper down 2.5mg every 2 weeks. So far, have gone from 25mg to 22.5mg with no issues, but this is still high doses so we'll see as I go down farther. We can all hope that our max RX for 2027 won't be too high. Blessings.

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jeff97 | @jeff97 | 15 hours ago
In reply to @boomermeg "@jeff97 That was insane I know. $8,000.00 just for Rx's alone! That must have been rough...." + (show)
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@jeff97
That was insane I know. $8,000.00 just for Rx's alone! That must have been rough.
I hope they keep it around 2100.00-2200.00 in 2027.

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@boomermeg I was assuming the maximum was going up $100 a year, but I just checked online and it will be $2400 next year. I might average it across the 12 months this time.

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boomermeg | @boomermeg | 14 hours ago
In reply to @jeff97 "@boomermeg I was assuming the maximum was going up $100 a year, but I just checked..." + (show)
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@boomermeg I was assuming the maximum was going up $100 a year, but I just checked online and it will be $2400 next year. I might average it across the 12 months this time.

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@jeff97 That's up $300.00. Thanks so much for letting me know. I'll find out if they'll let me do that average across the 12 months too. Good idea!

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jeff97 | @jeff97 | 13 hours ago
In reply to @boomermeg "@jeff97 That's up $300.00. Thanks so much for letting me know. I'll find out if they'll..." + (show)
Profile picture for boomermeg @boomermeg

@jeff97 That's up $300.00. Thanks so much for letting me know. I'll find out if they'll let me do that average across the 12 months too. Good idea!

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@boomermeg I just checked, and Google says that with a Medicare Advantage plan you can set up the out-of-pocket averaging at any time. I was thinking it might have to be during the open enrollment period. It's called the Medicare Prescription Payment Plan.

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boomermeg | @boomermeg | 10 hours ago
In reply to @jeff97 "@boomermeg I just checked, and Google says that with a Medicare Advantage plan you can set..." + (show)
Profile picture for jeff97 @jeff97

@boomermeg I just checked, and Google says that with a Medicare Advantage plan you can set up the out-of-pocket averaging at any time. I was thinking it might have to be during the open enrollment period. It's called the Medicare Prescription Payment Plan.

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@jeff97 thanks again. This is helpful. I'll look into it because that would help a lot instead of having to pay the $2400.00 (or whatever they do) all at once at beginning of year for 1st RX.
Really appreciate all your input. Blessings.

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