Orencia and Medicare Coverage | Arthritis Information


While I'm waiting for RA doctor's office to get paperwork done to start Orencia treatment, just remembered I will be on Medicare beginning August 1st.  I know Orencia is covered under our plan, but not positive about Medicare.   I don't really want to start this very expensive treatment, unless I know I can continue it (if it works).  Called the office back and left a voice mail message.   Does anyone know if Medicare will cover this one?  I couldn't believe that the cost is 00/infusion.  I almost feel guilty considering it!

Thanks, Sharon
Sharon, I don't know about whether Medicare covers it, but Orencia has a number just about insurance coverage and reimbursement programs.  See http://www.orencia.com/orencia/hcp2/content/content.jsp?BV_UseBVCookie=Yes&channelId=-9007800  i wonder what makes these meds sooo expensive
Thank you InnerGlow!  Will check out.  Hope you are having a good day!
I think it's all the research.  I'm still not sure I want to spend this money on one condition even if it is covered.
I'm sure some of it is the research.  I'll bet a lot of it is the pharmaceutical reps and the fancy literature (of which I have now been given oh about 8 copies) and the advertising to consumers.I use the Healthwell Foundation to pick up my copays for Orencia. With insurance, my copay would be 0 per month.I know with    medicare you have to purchase drug coverage. Yo pay  20% of  all  medical also. I bought  a suppplem=ent for about a 75 dollars that covers most    drugs and I    have  very small copay   and dont pat for any labs or   xrays. Now my copay for an     mri was      75 dollars I almost    fainted. I could not   take enbrel or humira because   I have to pay 33% of that drug cost because it   is what they call a high   tier(4). bUT AREMICADE INFUSION ONLY COSTS ME A25  DOLAR COPAY because its  considered an   officve          visit now  explain that. lol    It seems  like they would rather me have the drug      at home instead  of going to hospital oncology  center for treatment for  4 to    5 hours but  who  knowssorry I type so bad   Bad fingers and  bad skillsI "think" these drugs are expensive because they are trying to recoup money from the development of the drug, but also because it is a more involved process making some of these "biologic" drugs (they start w/live something or other, not like drugs made just from chemicals), and also because they want to make a profit.  However, infusion drugs administered in a hospital might be cheaper to the patient than say enbrel because of the way its billed to Medicare..
Also, consider the federal government is banned  from  negotiating with pharmaceutical companies for lower prices for prescription drugs covered by Medicare Part D.  The powerful pharmaceutical lobby was very influential in preventing this.  Congress has been trying to lift this ban, but Bush has said he would veto it.  This bill may have better luck passing w/the next Administration.
As health care costs go up, more costs are being passsed on to the consumer, as in the case of "Tier 4" drugs which are expensive "specialty drugs."  Biologics may sometimes fall into this classification, and the practice of charging 20 to 30% of the drug's cost which began with Medicare Part D plans, now is practiced by 10% of private insurance plans as they try to save money.  As someone who takes enbrel, I'm concerned, 0 a month would be impossible for me to pay.  I'm hoping we get a new President that will fix our messed up health care system, and implement an equitable system of affordable health care for all Americans.
Thank you all for your responses and good thoughts.  After looking on-line, I think I received wrong info from the receptionist at my doctor's office.   I think the cost is much lower than the 00/infusion she quoted.  When I hear back from the office, I hope I'll be relieved.  We are keeping our regular insurance as our supplementary to Medicare coverage.  It's expensive, but in my case I'm hoping it will pay off.  The coverage so far has been great.  Thanks again!

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