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Crohn's Disease Forum » Treatment » Remicade/Infliximab » Cost of Remicade in U.S.?


11-07-2013, 04:54 PM   #1
Mehita
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Cost of Remicade in U.S.?

Can anyone give me ballpark figures on how much Remicade costs in the US with and without insurance? We have Blue Cross Blue Shield.

Thanks!
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Mom of DS, age 17, dx Crohn's and Celiac Oct 2008
- Remicade, started Nov 2013, added Solumedrol June 2015
- added Methotrexate/Folate March 2016
- Multivitamins, Probiotics, Vit D
- Small bowel resection, Jan 2013
11-07-2013, 05:13 PM   #2
Clash
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We have blue cross blue shield too and C gets his infusions done at his GIs IV lab which makes a difference, I think the total cost is like 4200.00 but at the hospital it was going to be like 7000.00. Also we signed up for Remistart which covers what is left over after the insurance pays on the infusion med. Remistart isn't financially based nor based on whether you have insurance or not.
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Clash
Mom to
C age 19
dx March 2012 CD

CURRENT MEDS: MTX injections, Stelara


Dx May 2014: JSpA
8/2014 ileocecectomy
9/2017 G tube

PAST MEDS: remicade, oral mtx, humira
11-07-2013, 05:17 PM   #3
Clash
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If you look at the bill from the infusion center there will be the actual med then the things associated like the IV, benedryl, etc. Remistart covers the infusion med after BCBS pays its part.

I'm not sure how your BCBS is set up but ours pays 90/10 after deductible(350.00) then 100% after 1500.00 out of pocket. So C meets the out of pocket with the first infusion of the year and remistart covers the majority of that 1500.00 since it is paying for what is left over on med after BCBS and we ended up paying about 240.00 all year for Remicade treatments.
12-19-2013, 05:50 PM   #4
JohnT
 
Join Date: Dec 2013
I have psoriatic arthritis and receive a remicade infusion every 6 weeks. My doctor just sold his practice to Atlantic Healthcare Hosp System and my first infusion bill was $30,935.83. Fortunately, I am on Medicare and I have good supplement coverage.

According to the Hospital Claim submitted to Medicare the cost of the drug was
$29,397.83 the rest was for administration and various blood tests. However, the bottom line is Medicare paid the hospital $4,000 and my insurance paid an additional $1000. I have also seen ads for 4 100mg vials of remicade for $3,500.

John
12-19-2013, 10:34 PM   #5
nogutsnoglory
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It depends on your insurance policy, I don't pay a penny for the medication or administration of it. I'm not sure about out of pocket costs without coverage.
12-20-2013, 12:58 AM   #6
Mehita
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Wow, JohnT, that's crazy!

It looks like each infusion will be $2100 for DS and we pay 20% after insurance. This is for the med only. Remistart will be taking care of it this year.
12-22-2013, 06:59 PM   #7
MissD
 
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Every time I see these sorts of posts I thank my stars and God above for having been born in Australia. Im always just so amazed at how much things cost elsewhere. I just cant get my head around the medical side of the US. Like seriously, if you dont have health insurance over there you are fairly well screwed. And from what I can gather, if your job doesnt come with health benefits you gotta be a squillionaire to even afford health insurance. Am I missing something, or is my gist of it pretty much correct?

Im an official poor person here in Australia. So I am lucky enough to pay only $5.70 for each of my medications. Remicade and 6mp. As they are both on the government funded pharmaceticul benefits scheme even if I wasnt a 'poor person' they would cost 80 bucks each. Im not rubbing it in anywhere, Im just always so amazed at how other countries work and I see why there are so many people desperately tryin to get into this country by any means possible.
12-22-2013, 07:10 PM   #8
nogutsnoglory
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MissD I agree that the capitalist model of healthcare is horrible. You don't need to be wealthy to get coverage outside of a job but you need to have decent money because any quality plan that would cover drugs like Remicade can be quite pricey.
12-23-2013, 04:49 AM   #9
ThanksP
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It cost my insurance $1200-1900 for my infusion in the US (was always different). I only had to pay the $12 co-pay. Now that I live in Costa Rica, it costs me $3000 but I get 80% reimbursed by my US insurance company. I don't use the Costa Rican National healthcare because it would take years for me to be approved for Remicade, if it all.

It is my experience that without insurance, the cost is cheaper than what an insurance company pays. The same goes for procedures. The cash price is cheaper than what gets filed with the insurance company.
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Last edited by ThanksP; 12-26-2013 at 08:25 AM.
12-26-2013, 07:32 AM   #10
Fosterfamily2303
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If you look at the bill from the infusion center there will be the actual med then the things associated like the IV, benedryl, etc. Remistart covers the infusion med after BCBS pays its part.

I'm not sure how your BCBS is set up but ours pays 90/10 after deductible(350.00) then 100% after 1500.00 out of pocket. So C meets the out of pocket with the first infusion of the year and remistart covers the majority of that 1500.00 since it is paying for what is left over on med after BCBS and we ended up paying about 240.00 all year for Remicade treatments.

wow...which BCBS do u have? I have BCBSIL and i have a cooay of $1500 to meet 80/20 and then ded of $3000 to get 100%
12-26-2013, 07:39 AM   #11
Clash
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We have BCBSIL as well, through Hubby's employer. Up until last year there was no premium but now it is 75$ a month, family of 4. Our deductible and out of pocket will probably go up this year, unfortunately.
01-02-2014, 04:48 PM   #12
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Each infusion costs I get costs $11,000, but my co-pay is only $150. Once I reach the $500 out-of-pocket mark annually, I don't have to pay anything.

I was shocked when I saw the first bill. I think most of the charge is for the hospital, and not the drug itself. Medical costs in the U.S. are insane.
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Diagnosed with Crohn's Disease Oct 1982; Rheumatoid Arthritis Nov 1985; Ankylosing Spondylitis June 2015
Taking 150mg Azathioprine; Remicade, Tramadol, Celebrex
Been there, done that: Sulfasalzine, Pentasa, Asacol, Prednisone, Budesonide, Cimzia, and more colonoscopies than I can count
06-07-2014, 03:52 PM   #13
dkl2829
 
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My son has had Crohns since 2002 at age 17. He was put on remicade in 2004. THe cost at that time and up to 1/1/2014 was $6600.00, our part was about $400.00. He always got his infusions at the Rhuemetology office. The location was switched to a hospital infusion center and our bill for 2/2014 was $25,000.00, our part $1600.00. I have not been able to get an answer about the price change. I lost my ability to keep him on my work;s COBRA insurance 3/1/14 after 3 yrs. He get treatments ev 2 months. We were going to cancel the April appointment as we haven't been able to get him any insurance yet. We were directed to medicaid and they are on a 5 month wait list!! Dr said he has to get treated or develop anitbodies, so we treated in April, are now in debt the $25,000.00. Still no word from medicaid and June treatment is due. We have Remistart, and also applied to Johnson & Johnson. We'll see. I'm afraid if he is denied medicaid though, is there an insurance co that will pick him up. THanks for the forum. I am just overwhelmed and so worried for his health. No flares for over 10 yrs.
06-08-2014, 07:01 AM   #14
my little penguin
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https://www.healthcare.gov/health-in...e-marketplace/

Check the insurance marketplace.
If he has had no flares in 10 years -is there a reason he doesn't have his own insurance through his work? Since that would make him 29 correct?

Have you look at infusions at other adult places near you -asked about cost etc....?
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06-08-2014, 07:10 AM   #15
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Since our son gets admitted to the peds floor of the hospital, our first bill was $10,000 (ugh!) covered at 90% until we meet our $2500 deductible with BCBS. So, thankfully, his second infusion will be completely covered!
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Son diagnosed at age 12, December 2014

Current meds: Remicade every 8 weeks (May 2014)
Past meds: Prednisone, 6MP and 3000 mg Pentasa
06-08-2014, 09:35 AM   #16
Alley2231
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I have Blue Cross Blue Shield of North Eastern NY....all I have to pay is a $20 co pay when I go for Remicade. The hospital charges a little over $7000 for each infusion. I have a really crappy paying job, but my insurance is phenomenal!
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Carrie

Diagnosed with Crohn's Disease - January 2014
Verified Crohn's Colitis - April 2014

Current Meds: Cimzia
Azulfidine (for joint pain)

Past Meds: Remicade, 6MP, Pentasa

Supplements: Calcium, D3, B12, Folic Acid, Probiotics


Blog: http://imacrohnie.tumblr.com/
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