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.