How much is Remicade without insurance?

Is Remicade covered by insurance? | How much does Remicade cost without insurance? | How to get Remicade without insurance

Remicade is a brand-name drug prescription medication used to treat various autoimmune conditions, which are caused by the immune system attacking healthy tissues in the body. It is approved to treat rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, plaque psoriasis, Crohn’s disease, and ulcerative colitis. Remicade can be an expensive specialty drug because the process to manufacture it is more complex than that of other drugs. It is generally administered as an intravenous (IV) infusion in a doctor’s office, outpatient clinic, or hospital. Medicare and insurance companies may help cover the cost of Remicade, but the exact cost can vary.

Continue reading to learn more about Remicade and how to save on Remicade without insurance.

What is Remicade?

The active ingredient in Remicade is infliximab, a monoclonal antibody. It works by blocking the action of a protein involved with inflammation called tumor necrosis factor-alpha (TNF-alpha). Remicade, like other TNF blockers, can help reduce symptom flare-ups and increase the amount of time between flare-ups. 

Remicade is administered as an IV infusion over a period of two hours. Remicade infusions are usually given every eight weeks by a healthcare professional at an infusion center, outpatient clinic, doctor’s office, or at home. The usual dose of Remicade is  5 mg per kilogram of body weight, although the actual dose can vary depending on the condition being treated. 

Remicade can be expensive as a brand-name drug with no generic versions available. Without health insurance, there are ways to make treatment affordable.

Is Remicade covered by insurance?

Remicade may be covered under some commercial insurance plans. If Remicade is covered, an insurance company may first require prior authorization, a letter of medical necessity or exception, and appeals before approving the prescription.

Health insurance can certainly help make Remicade treatment affordable, but the out-of-pocket costs could still be high. What a patient ends up paying will depend on the formulary, copay cost, deductible, and coinsurance amounts outlined in the health insurance plan’s policy. Some eligible patients with commercial insurance can apply for the Janssen CarePath Savings Program to reduce their out-of-pocket costs.

Remicade may be covered by Medicare Part B and Medicare Advantage plans. However, people on Medicare may find one or more infusions may be more costly because of a coverage gap. Medicaid may also help cover Remicade, depending on the state’s Medicaid clinical policy. 

RELATED: How much does Medicare pay for Remicade infusions?

How much does Remicade cost without insurance?

Remicade could cost around $4,000 to $7,000 or more per dose. That can add up to about $46,000 if Remicade is given every eight weeks for a year. However, the actual price can vary depending on the healthcare provider administering the infusion, location, and other factors. The Remicade dose is based on weight, so people with a higher body weight may pay more per dose than others. 

If Remicade is too expensive or coverage is denied, a healthcare professional may be able to prescribe a less expensive alternative. An FDA-approved biosimilar drug called Inflectra (infliximab-dyyb) is nearly identical to Remicade. Inflectra is just as effective and safe as Remicade, but it is about 40% cheaper than Remicade. 

Other drugs have similar effects as Remicade on the immune system to control or reduce symptoms of autoimmune diseases. The alternatives fall under a group of drugs called biologic disease-modifying antirheumatic drugs (DMARDs), which includes TNF blockers like Remicade. Biologic DMARDs include Cimzia (certolizumab pegol), Humira (adalimumab), and Enbrel (etanercept).

Unfortunately, alternatives to Remicade can be expensive brand-name drugs. People without insurance coverage may need to take more affordable nonbiologic DMARDs, such as corticosteroids, Trexall (methotrexate), Sandimmune (cyclosporine), Arava (leflunomide), Azulfidine (sulfasalazine), or Azasan (azathioprine), for autoimmune disease flare-ups. 

Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. The listed price without insurance references the price of brand-name drugs. The listed SingleCare price references the price of generic drugs if available. Click the link under “Savings options” to see updated drug prices.

How to get Remicade without insurance

Remicade can cost $7,000 for one dose, plus other miscellaneous costs for the infusion. People without insurance can turn to the Johnson & Johnson Patient Assistance Foundation, although there may be eligibility requirements that not everyone can meet. Rest assured, there are ways to reduce the cost of Remicade as long as you’re willing to try more than one strategy. Here are some ways to save.

1. Ask the prescriber about traditional DMARDs

If none of these strategies work, consider switching to more affordable traditional DMARDs. There may be trade-offs, so ask the prescribing healthcare provider for medical advice about your alternatives.

2. Use a SingleCare discount card

A free coupon from SingleCare may reduce the cost of Remicade by over $5,000 if Remicade is purchased from a specialty pharmacy for home use. However, Remicade is rarely purchased directly from pharmacies by patients since it is administered as an IV infusion. 

3. Get a health insurance policy

A year’s worth of Remicade treatment could easily top $46,000 or more, and that doesn’t include the additional fees for the infusion and any tests needed before starting treatment. At such a high price, health insurance is probably one of the best ways to save money. Make sure to consult an agent when evaluating health insurance plans and check the plans’ policies regarding specialty drugs like Remicade.

4. Enroll in Medicaid

For some people, private health insurance is unaffordable. For people who can’t afford private health insurance, Medicaid is a possible option for getting Remicade. However, some state Medicaid plans may not cover Remicade. Start by visiting your state’s Medicaid website for enrollment and eligibility requirements, as well as your state’s Medicaid formulary information. Talk to someone in your state’s Medicaid office to see if Remicade infusions are covered.

5. Consider all the costs

Medication costs are only a fraction of the overall cost of Remicade. In addition to the cost of infusions, office visits and tests can add hundreds or thousands of dollars to the overall cost of treatment. Other potential costs may need to be taken into account; for example, a serious allergic reaction during an infusion may cost thousands of dollars in emergency medical treatment. Ask your healthcare provider for an assessment of all the benefits, costs, and risks involved with different treatment options to find the best treatment for you.