Medicare and Actemra

[Aleish]

Is Medicare coverage available for Actemra?

[Klah]

I think Medicare will cover 1/2 of the infusions, your secondary may cover the second half. Your separate pharmacy coverage, depending who it is, will cover the

Injectibles...still very pricey! Hope you can try it😊

[30048]

I was told that Medicare would cover the infusion but not the shot. I did get a waiver from my insurance and the co pay for the shot was $ 641. I guess ..the infusion is considered a procedure and the shot a prescription,

[Aleish in reply to 30048]

I was told for GCA it had to be the shots if they were to pay. RA it's the infusion s. I'm going to call the manufacturer in am and try and get this figured out.

[Aleish in reply to 30048]

Also , don't you have a supplemental or are you in a pop?

[Hindags]

Anyone with PMR only who has gotten Actemra paid by Medicare or their US insurance? If so, how did you get qualified?

[Aleish in reply to Hindags]

PMR is not approved for Actemra with Medicare but GCA is.

[Aleish in reply to Hindags]

Call Actemra and they will get you into a paid program.

[Nap1]

Yes