Questions for people taking Actemra and Kevzara injections

I started taking prednisone in late June 2024. I'm at 1 mg now, and I only have 12 days left to take it. I'm really looking forward to being done with it.

I am covered by a federal plan and receive my injections by UPS in a cooler with ice packs. When I first started my prescription, I received them 2 at a time until something delayed delivered and I missed a week. I informed my rheumatologist of the missed dose and delay and he spoke with my pharmacy. From that point on I receive 8 vaccines at a time and usually get the next dose when I am down to 2 doses. Honestly don’t know what changed but I assumed it was the way he ordered the medication.

Infusions are more expensive than injections and I understand that some insurance companies require the doctor to inform them if an injection is possible or not. Hope that helps. Blessings!

Yes, that helps, thanks. The difference between insurance plans is interesting.

"Infusions are more expensive than injections and I understand that some insurance companies require the doctor to inform them if an injection is possible or not."
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The cost analysis is complicated and depends on many factors and how it is analyzed. The administration cost of doing an IV infusion is certainly an added cost to an insurance company. The out of pocket cost to the patient might be much less when out of pocket maximums and insurance coverage are considered.

Infusions may be covered under Medicare Part B, while injections fall under Part D.

The cost of only the medication is less when given by infusion. I'm sure hospitals buy medications in bulk supplies and get discounts direct from the company.

There are other costs to the injections like shipping and handling along with wastage caused by expiration dates, improper storage and other reasons.

I was aghast when a patient said she still had syringes left when Actemra was discontinued. The patient was told to throw the unused syringes away.

The specialty pharmacy is in the same town and I can go to pic them up of they send it to me refrigerated. I get two shots of Kevzara sent to me every two weeks. I am surprised that you have to go so far for a specialty pharmacy and that they will not send it to you.

I apologize if my post was confusing. They do ship the Actemra to me. It usually gets delivered within 12 hours of when it was shipped. I'm just surprised that the pharmacy is so far away. I live in a fairly populated area, and there are several other cities not too far away.

When I was getting Kevzara injections through the patient assistance program, I got 2 syringes a month flown overnight from the east coast to the west coast! They came in a styrofoam cooler with ice packs. I avoid anything disposable and don't fly personally due to the carbon footprint so this seemed extremely wasteful. Luckily I live in a lower income neighborhood on a walking and biking route so I put the cooler and ice packs on the curb and they were taken within a few hours!

'Insurance coverage for dummies' - I need this
We had Medicare and federal bcbs for a long time and it just got too costly so we switched to a federal Medicare advantage plan which has worked well and saving money. I have several prescriptions all with minimal copays. It appears a biologic will cost $350/month until I reach $2000 for the year. Kevzara is injection only so there is no getting around the cost with an infusion instead. In researching Aetna Actemra coverage, it appears that it can be approved for pmr if you can meet one of their requirements which could be difficulty tapering prednisone - that's me. However, I don't see Actemra infusion in the formulary - only injections. That's as far as I researched. I didn't think you could get Actemra with a pmr diagnosis but it looks like a possibility.
I am at 3 mg prednisone, going to wait a couple months before trying to taper lower again.
Do I think I could get Actemra infusion covered with no copay? I don't know. It's a 'rabbit hole'.

My doctor had to jump through some hoops to get Actemra approved for PMR. The authorization request mentioned being unable to taper off prednisone. The other factor was that all other suitable alternatives had failed … notably methotrexate.

How are you doing on 3mg. Even with Actemra, I had to stay on 3mg for 6 months to allow time for my cortisol level to improve. Actemra prevented a flare of PMR. Otherwise I wouldn’t have been able to stay at 3 mg let alone taper off prednisone.

I have a bcbs Medicare advantage plan, and for the first 4 injection order of Actemra I got this year, the copay was $1850! I had a $17 copay on another medication, and that was the end of my copays for this year. For some reason they decided those 2 copays combined met the $2000 limit for the year.