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How hard is it to get on Actemra (Tocilizumab) with PMR?
Polymyalgia Rheumatica (PMR) | Last Active: Apr 2, 2023 | Replies (51)Comment receiving replies
If I used the shots it would be $4k a dose. Who can afford that?? Not me! When my RA came back active my rheumy, who was beside herself at the level of pred I have to be on to function, decided we should try infusions of Actemra. I checked the cost and you'd hernI eo I ld do it but not if the plan was to start with infusions then switch to shots. I think the cost is crazy! Especially since this is a condition that affects older people...a lot whose incomes have been reduced. She said no.just infusions. I hope so. We got delayed because of some infections that are almost done. Hopefully I will hear soon. But.I wish something could be done about the costs.....insane even with their help.
Replies to "If I used the shots it would be $4k a dose. Who can afford that?? Not..."
I was worried about you when you said you had a long history of RA. All I can say is things get complicated when you have other autoimmune disorders along with PMR.
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Hello my friend!
Medicare will pay for infusions of Actemra because they are given in a "hospital setting" like an infusion suite. Infusions are done by hospital personnel as compared to injections that are self administered at home and done on an outpatient basis.
Unfortunately, Medicare will only pay for 80% of the cost of the infusions. The remaining 20% is still a lot of money. With your RA diagnosis, Actemra is FDA approved so you won't need any other approval.
Do you have a Medicare supplemental plan? That should cover the remaining 20%. I'm not sure how the Medicare Advantage plans work. Legally, I think those types of plans are required to cover medications that are FDA approved for the diagnosis being treated. But again, the Advantage plans will only pay for the infusions.