I realize this is an odd question. As I was sitting in a chair getting my Remicade infusion, for some reason this popped into my brain. I constantly see Enbrel and Humira ads, but have yet to see a single Remicade ad. Anyone else notice this?
That is interesting. Is remicade a different kind if biologic (aside from being an infusion)? It must be cheaper because in the U.S. we have to switch to it at age 65 or when we go on government health insurance (medicare). For me, that'll be disappointing if Enbrel is still working well and I have to switch. I don't like the idea of having something "working" in me for 6 weeks (just in case there are severe SEs)--that's why I chose Enbrel, cuz it's once a week.
Hmmmmm, that is interesting. Might be because their market is different – sounds as if their niche is the Medicare market, which has few consumer choices. For the rest of the PsA population, there is an element of consumer choice. So Humira and Humira want to encourage people to ask their doctors for their specific drug.
Here’s something else that’s interesting: while our US friends on Medicare are pretty much forced to go on Remicade, in the province where I live, Remicade is the one anti-TNF therapy not covered by our seniors’ government health care. Enbrel and Humira can be accessed with special permission (a detailed application from a specialist), but Remicade isn’t available at all. I suspect that is because of the additional costs to the system for the infusion.
My rheumatologist told me that Remicade's parent company have their hands pretty deep in the pockets of those who make choices about Medicare, and the infusion centers are deep in those pockets, as well. The actual cost and the efficacy of the biologic medications don't vary all that much.
- I hope that changes sometime in the next 4 years. I don't think it's fair that we have no choice once we go on medicare.
Respectfully, you rheumie is full of it. There is a glitch in the part B medicare, that also effects most major medical plans. The Senate passed a correction years ago (well 5 anyway) that correctected that situation, as well as changed coverage tiers for all biologics. Unfortunaltley, it is a part of the AHC, and even though it would save many millions of dollars, there is no way it will move in the house despite broad bi-partisan support. Jannsen doesn't make a dime off infusion, although a lot of rheumies do. The reason it isn't advertized is simple. Johnson and Johnson has newer meds on which the patent has not expired.
You have all kinds of choice on medicare, depending on what you choose for part D coverage.rosen said:
My rheumatologist told me that Remicade's parent company have their hands pretty deep in the pockets of those who make choices about Medicare, and the infusion centers are deep in those pockets, as well. The actual cost and the efficacy of the biologic medications don't vary all that much.
What was the glitch?
The glitch is that hospital based procedures are covered by major medical/medicare part B coverage. This can be a good thing or a very bad thing depending on your deductibles medicare supplement etc.
My gripe is too many docs are clueless, and far too many Rheumatology practices in order to increase cash flow are opening infusion centers unaware that for the most part few patients can afford them. These office based infusion centers are ill equipped to handle an emergencey that happens with Remicade. (think Joan Rivers)
In any event Practice Managers and Physicians are regularly blaming the drug companies, when in reality what they are looking for is supplements from the drug companies.
These supplements of course are not available for medicare patients as it is illegal (as it should be) to offer finacial incentives to medicare/medicaid patients.That's interesting. A few years ago, my family member was unable to switch to an oral version of her cancer medication because it was available via infusion, and since she didn't have part D at the time, she had to continue with the infusions under part B.
That's an understandable gripe. I think a lot of practices take on stuff they can't handle in order to increase income. I don't think my rheumatologist does anything with infusions at his office, and he's been pretty spot-on otherwise (this is the new guy), but it's probably hard for any practitioner to not resent the insurance and pharmaceutical companies after years and years of fighting with them over reimbursement and costs of treatment... I don't know if that makes sense.
Do you think that Remicade is less marketable because it requires infusions at a clinic, and that's why there are less commercials?
Rheumatology practices have the same overhead as any practice. The problem is they are only able to bill for intellectual time. Aside from a few injections (which I would likely never have a rheumy do) A "fast paced run'em through" may actually schedule 20 patients in a day. (15 is more like it) No matter how you cut it that doc in the US anyway is only producing 4-6 thousand a day in GROSS income A DAY.If they have a high portion of medicare patients it will be less. The average doc has a staff of 6 between assistants receptionists coders etc etc They are not exactly. holding a tin cup, but because they have little to sell but their brain power and time they are among the lowest paid of the sub specialties.
While patients may not be thrilled their doc won't call them on the phone to discuss their case when questions come up, they need to remember the cardiologist up the hall with the same amount of time training could bill 30K for inserting a stint.in the same amount of time the doc pulls the chart, reviews it, makes the call, charts it and dictates the followup. he could also have seen a 21st patient for the day.
Infusing remicade is a piece of cake. dealing with a reaction that can happen at anytime no matter how many previous infusions the patient has had can be more than a tad bit dicey. Even in a surgi-center they had to call an ambulance for Joan Rivers......
We are seeing a lot more office use of sonograms, but not often is there a codable procedure. There is no lack of patients for Remicade. It treats a broad range of diseases. There really isn't a need to advertise it as it is growing by about 15% per year. but their ability to market ends in 4.
Jannsen has 4 really hot biologicals in latter trials expect to really be game changers
- Daratumumab — an experimental treatment for multiple myeloma that uses entirely new technology
- Sirukumab — an experimental treatment for rheumatoid arthritis .
- Guselkumab — an experimental treatment for psoriasis, psoriatic arthritis and potentially other auto-immune diseases. They were able to make an interleukin-23 exclusive. Phase II data shows an 88% CURE rate for psoriasis
- Fulranumab — an experimental treatment for osteoarthritic pain that it licensed from Amgen.
They spend their money on Physician and staff "training" For the cost of one prime time commercial, they can bring 40 physicians and key staff to Hawaii for a week of training.................
Makes sense. It's too bad that rheumatology is such a poorly reimbursed profession. They treat incredibly complex and complication-ridden illnesses.
The guselkumab--aren't there cure results for PsA?
Also, Idk much about medicare, parts B and D, etc., but are you saying by choosing a certain one I would have more options, such as coverage for Enbrel?
Yes. you would have more options. The secret is to cover the Donut Hole: Believe it or not Walmart is a great place to shop as is Walgreens for these plans:
THE PART D STANDARD BENEFIT
At a minimum, plan sponsors must offer a "standard benefit" package mandated by law. The standard benefit includes an annual deductible and a gap in coverage known as the "Donut Hole." Sponsors may also offer plans that differ from – but are actuarially equivalent to – the standard benefit. Finally, they may also offer "enhanced" plans that provide benefits in addition to the standard benefit. Typically, the enhanced plans offer some coverage during the Donut Hole.
The Standard Benefit is defined in terms of the benefit structure, not the drugs that must be covered under the plan.
In 2014, the Standard Benefit includes an initial Annual Deductible of $310 (the maximum allowed under law) (2015 – $320). This is called the Deductible Phase, or Stage 1.
After meeting the deductible the beneficiary pays 25% of the next $2,540 ($635) (2015 – $2640/$660) in formulary drugs. This is called the Initial Coverage Period or Stage 2.
Once the plan and the beneficiary have together paid the Initial Coverage Limit of $2,850 ($310 + $2,540 = $2,850) (2015 – $320 + $2640 =$2960), the beneficiary has a gap in coverage known as the "Donut Hole," or Stage 3.
During the Donut Hole the beneficiary pays for 100% of the next $3,605 (2015 – $3720) in formulary drugs, subject to a brand discount of 52.5% or a generic discount of 28%)
Once the beneficiary has spent a total of $4,550 (2015 – $4700 = $320 + $660 + $3720)in "true out-of pocket costs" (TrOOP) in formulary drugs, he/she enters the Catastrophic Coverage Period, or Stage 4.
During Stage 4 the beneficiary pays 5% of the cost for formulary drugs, or $2.55 for generics and $6.35 (2015 – $2.65/$6.60)for brand name drugs, whichever is greater. Beneficiaries who meet the $4,550 out-of-pocket threshold remain in Stage 4 for the rest of the calendar year. The process begins over again the next year.
Medicare does not establish premium amounts for plans. Instead, premiums are established through an annual competitive bidding process and evaluated by CMS. Medicare does establish the maximum deductible amount, the Initial Coverage Limit, the TrOOP threshold and Catastrophic Coverage levels every year. The standard benefit is slowly phasing the donut hole
Alternatives to the Standard Benefit (this is where you need to shop)
Most plans do not follow the defined Standard Benefit (DS) model. Medicare law allows plans to offer actuarially equivalent or enhanced plans. While structured differently, these alternative plans cannot impose a higher deductible or higher initial coverage limits or out-of-pocket thresholds. The value of benefits in an actuarially equivalent plan must be at least as valuable as the Standard Benefit.
CMS distinguishes two types of actuarially equivalent plans:
Actuarially Equivalent (AE) plans – have the same deductible as the standard benefit but have different cost-sharing. Instead of a flat 25 % co-insurance during the Initial Coverage Period, they may employ a system of tiered co-payments on groups of drugs.
Basic Alternative (BA) plans – have a smaller deductible, with or without different cost sharing, such as tiered cost sharing.
In addition, Enhanced Plans (EA) offer a benefit package more generous than the Standard Benefit. Most typically, they include coverage of some drugs during the Donut Hole.
For most of us we are better off spending our $$ on the Part D and less on the Bart B supplement........... A good agent will be able to run various models for you. But you spend a lot more on meds than you do being in the hospital......
My husband is turning 65 May 2 and will retire and go on medicare then. He's on tons of meds, but none of which is as costly as Enbrel. Hopefully we'll also learn a lot about medicare during the next few years while he's on it before I turn 65. My mom buys a supplement, which is to help pay for meds, and she pays under $150 a month for it and a very minimal copay on some of her meds and no copay at all for others.