I was quite stunned when I saw some forums where people were taking about an infusion of remicade costing anywhere from $2,000 to 5,000… I am in Australia and trying to find information on medication costs and entitlements is proving difficult, so I thought I’d ask you guys. It’s more out of my own curiosity in case I can’t handle methotrexate, which I’m thinking will most likely happen due to my recent severe vomiting, fatigue and severe headache and dizziness episode which occurred with the last dose of Mtx. I was wondering how much it costs per infusion in Australia and is it covered by Medicare? Or private health insurance? Or is it an out of pocket cost. Thanks for any info xox
FYI Arava (leflunomide) is an alternative DMARD to mtx. MTX and I don't mix, even with injections, but I do just fine with Arava.
You may want to call the company that manufactures Remicade. They may have advocates to help you get the medication, and payment assistance programs to help.
My understanding is that Remicade is approved on PBS (pharmaceuticals benefit scheme) and only costs about Au$300 a year on Medicare. I don't know if that covers infusion costs as well. Sometimes its done in an infusion center, but increasingly is done in a hospital because of infusion reactions.
Heres the "rules" http://www.medicareaustralia.gov.au/provider/pbs/drugs2/psoriatic-a...
There are "special rule for Remicade (infliximab) that are about as clear as mud on infusion.....
As many of know after market studies have come up with a new dosing schedule essentially every six weeks instead of every 8. The bad news is the new protocols also include MTX as apart of them. OZ adopted the mew protocols in April (I think, they adopted them anyway) Don't know what the protocols are without MTX
Lamb has it right, as long as you are eligible, and as I haven’t had infusions, I’m also not sure of those costs. You do need to meet the eligibility criteria though - if you look at the initial application form, it has the specifics, but you need to fail MTX and one other dmard after a 3 month minimum period of each. You can fail MTX by not tolerating it, but the have some very specific toxicity criteria (also on that page lamb posted the link for).
In addition, there’s a bit about ESR and CRP. Mine have never been high - we used the excuse that I’d been on long term steroids. I’d suspect that the Rhuemy can fill it out so that you’ll be eligible if he wants you to be - the key thing will be getting his / her support for it.
If you want to go to any of the biologics without going through the waiting periods, then you’ll have to pay the full amount - I think it’s about 28k per year for remicade, and I doubt there’s much in the way of support set up because of the Medicare PBS.
Thanks guys, I can definitely wait it out and try everything first. I was noticing a difference on the Mtx already after only 4 weeks, my joints weren’t so stiff and the swelling in my right hand settled down. I can currently off the Mtx as the rheumy said I was showing signs of toxicity with the severe vomitting, severe headaches, fatigue and dizziness. And she is starting me on a very low dose This time at only 5 mg and then slowing increasing it again. She said unfortunately I have to try it for a certain amount of time with varying dosages and changes in my folic acid intake as well before I can move onto something else. She commented she thinks the Mtx may not be the right drug for me given my side effects. I am due to see her in 2 weeks and she will have my latest bloods. Thanks for the info guys, the was just worried that if the DMARDs didn’t work I might be up for huge costs for a biologic, but I don’t think it will be so bad from what you guys are saying with the PBS covering it and I have pretty good private health cover too that will cover any hospital admission. Thanks guys take care