Medicare/Remicade Question

[Guest guest]

My friend currently takes Enbrel for psoriatic arthritis. She is 65 and

medicare has something called the donut hole and she has to pay over

$3000.00 a year for her medication. Her doctor has offered to switch

her to Remicade if that would be cheaper for her. Of course, Medicare

won't tell you anything until you actually switch. We were thinking

that if she gets remicade in the hospital, the charge won't be for

medication but for treatment and it would be covered. Anyone have

experience with this? We live in Pennsylvania but I dont think that

would matter. Thanks in advance for all your help.

[Guest guest]

I googled and found this:

Medicare Coverage of REMICADE

Medicare covers most physician-administered drugs like REMICADE under

Medicare Part B. There are comprehensive published Part B coverage

policies specific to REMICADE. Copies of coverage policies are

available on your local carrier or fiscal intermediary websites, and

these can be found in the Billing and Reimbursement section of this

website.

Medicare typically places few restrictions on REMICADE coverage. Some

Medicare policies may limit coverage of REMICADE to certain diagnoses,

such as:

Crohn's Disease

Ulcerative Colitis

Rheumatoid Arthritis

Ankylosing Spondylitis

Psoriatic Arthritis

Plaque Psoriasis

You can check your local Medicare r or Fiscal Intermediary

website for coverage policies for REMICADE or call AccessOne® at

1-888-ACCESS-1 (222-3771) for more assistance.

Sue

On Tuesday, November 11, 2008, at 05:10 AM, maggiemac52 wrote:

> My friend currently takes Enbrel for psoriatic arthritis. She is 65 and

> medicare has something called the donut hole and she has to pay over

> $3000.00 a year for her medication. Her doctor has offered to switch

> her to Remicade if that would be cheaper for her. Of course, Medicare

> won't tell you anything until you actually switch. We were thinking

> that if she gets remicade in the hospital, the charge won't be for

> medication but for treatment and it would be covered. Anyone have

> experience with this? We live in Pennsylvania but I dont think that

> would matter. Thanks in advance for all your help.