I'm blessed too because I receive Actemra infusions at the VA. The VA submits an insurance claim to my Medicare supplemental insurance. The VA gets reimbursed for 20% of the cost of doing the infusion. The cost of medication is rolled into the cost of doing the infusion. My out of pocket cost is zero since the VA does the infusion.

I don't think Kevzara is available as an IV infusion. Biologics are considered "outpatient medications" when administered as an injection just under your skin (subcutaneous). Outpatient medications are covered by Medicare Part D but it depends on which Medicare Part D plan a person has. I get my medications from the VA so I did pay a small copay when I was doing Actemra injections.

My rheumatologist at the VA felt that Actemra should work for me even though I have only been diagnosed with PMR. I have several other autoimmune conditions including PMR. Actemra is only FDA approved for GCA. I have never been diagnosed with GCA and Actemra isn't FDA approved for PMR or any of my other autoimmune conditions. My rheumatologist submitted an authorization request and got Acterma approved for me to treat PMR.

Actemra can be given in two different ways. The medication can be given as an intravenous (IV) infusion by a healthcare professional in a doctor’s office or an infusion clinic. Actemra infusions take about 60 minutes and are given every 4 weeks. Medicare Part B will cover 80% of a biologic which is given in a "hospital setting" by IV infusion so long as it is FDA approved for the condition being treated.

I'm very pleased because Actemra seems to work for PMR and all my other autoimmune conditions. I don't seem to have any side effects from Actemra.

I had many side effects from prednisone and my overall health and quality of life deteriorated during my 12 years of treatment with prednisone.

@wilmingtonemperor ha ha - don't faint - you are missing a zero -- when put Kevzara (tier five drug) on my compariosn list of for Part D is it >50K$ on my current plan. So i did change plans for 2024.