How does Kevzara help with PMR symptoms and pain? I am being weaned

My inflammation markers have been normal since my first 15 mg dose of prednisone 16 months ago. I started noticing pain returning when I tapered to 10 mg. I’ve continued to taper but pain has been an issue. My rheumatologist suggested that if the physical therapy I’ve started doesn’t help then Kevzara would be the next choice. I’ve just discovered that Kevzara is a tier 5 (barely covered) drug in my Medicare prescription drug plan. Here’s hoping that the PT works.

Oh damn. We can’t win for losing. It’s amazing what Medicare part B and D will
NOT pay for.

I had trouble tapering below 10, finally got to 8 but no lower. Methotrexate allowed me to get fairly easily to 5 but I had a recent flare-up and am up to 6.5, hopefully temporarily. My rheumatologist brought up Kevzara at my last visit. I was concerned about cost, reading that it was $1-2,000 a month. I went on Medicare.gov and looked up what my cost would be. I'm on the cheapest Part D Silver Script plan at $1.60 a month. Kevzara would cost $280 a month and I could apply to the drug company for help with the co-pay. I could handle that ( I know lots of people couldn't) so now I'm less worried. If it gives me good quality of life I am starting to think I can handle the possibility of more severe side effects that what I am on now.

Are you just on Medicare? I was on drug manufacturer rebates for my RA biologic - Humira at the time and a $1200 drug cost me $10. But I would not have been elegible if I had been on Medicare at the time. Only available to patients on private insurance is what they told me.

Yes, just Medicare. I was not counting on getting help from the drug company but saw that there was an application process. I don't know their rules. $280 a month is a lot but better than a grand or two!

Well i hate to be the one to inform you that years ago when congress wanted to establish a part D for drug coverage, they agreed to accept not beeing able to negotiate prices at all for patients on Medicare Or Medicaid… including coupons they offer anyone with private insurance. Talk about a ripoff!

It's illegal for pharmaceutical companies to offer discounts for medications that you purchase through Medicare due to the Social Security Amendments of 1972. Included in those amendments is the Anti-Kickback Statute (AKS).Dec 12, 2023
Some people Are Hopeful and they have listed specific drugs - like One a year or such - that they will Negotiate for lower Prices.

The cost of Kevzara is horrendous and the company really should be ashamed of itself for pricing it this high. For me it would have been over a thousand a month for two injections. But there are a number of workarounds. The company does provide help. My insurance provides some help. The specialty pharmacy (accredo) Kevzara comes from helped me look at all the options. Provided nursing support, etc. I pay nothing. Additionally my doctor had a kind and thoughtful workaround with the drug being administered by transfusion in his office once a month If I wasn’t able to work out having injections shipped to my home For a fraction of the amount. It was a bit complicated but it all worked out. Do not let the cost deter you from trying it before looking at the options for covering the costs.

I have a knack for making excess bone. I'm not sure why it happens but I developed extensive areas heterotopic ossification after knee replacements.
https://pubmed.ncbi.nlm.nih.gov/11884494/#:~:text=Abstract,or%20central%20nervous%20system%20injury.
The surgeon who wants to do a lumbar fusion says I have a lot of bone but it probably isn't "good bone." I wasn't on Actemra when it was discovered. I was on high dose prednisone which was why the lumbar fusion wasn't done. Heterotopic ossification is a healing process that goes awry. The recommendation is that I shouldn't have anymore surgery.

Please keep us informed on how it goes, sounds like it’s good news so far.

Crossing fingers and toes Kevzara will be a success!!