Medicare and Actemra : Is Medicare coverage... - PMRGCAuk

PMRGCAuk

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Medicare and Actemra

Aleish profile image
8 Replies

Is Medicare coverage available for Actemra?

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Aleish profile image
Aleish
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8 Replies
Klah profile image
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 profile image
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 profile image
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 profile image
Aleish in reply to 30048

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

Hindags profile image
Hindags

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

Aleish profile image
Aleish in reply to Hindags

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

Aleish profile image
Aleish in reply to Hindags

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

Nap1 profile image
Nap1

Yes

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