Remicade, which is a brand name for the drug infliximab, is primarily used to treat certain autoimmune diseases. If you have been diagnosed with ulcerative colitis, psoriasis or psoriatic arthritis, Crohn’s disease or rheumatoid arthritis, your doctor may prescribe Remicade infusions to help you manage your condition. Medicare benefits that help cover the cost of this treatment may be available.
How Remicade Works
The administration of Remicade is given via intravenous infusion. These infusions must be given slowly, so individual treatment sessions may last for up to 2 hours or more. Depending on your treatment plan, this occurs in intervals of six to eight weeks. Oral delivery of this medication is not possible because the digestive process will destroy it.
Some autoimmune diseases cause the body to produce too much of a certain protein or cause the immune system to react abnormally to these proteins. Inflammation and other painful symptoms occur as your immune system tries to regulate its response. As a synthetic antibody, Remicade prohibits certain proteins in the body from causing these symptoms. By binding to these protein cells, it prevents them from triggering an immune response.
In order to improve Remicade’s effectiveness, you may be prescribed other medications that help your body respond properly to these infusions and prevent your immune system from developing antibodies to fight Remicade. Your prescriber can help you assess the most comprehensive treatment plan for your conditions.
Side Effects and Risks Associated with Remicade
Because this medication inhibits certain immune responses in order to treat the underlying medical condition, you may be vulnerable to unrelated infections. These can include common upper respiratory infections in the throat and sinus, but it can also induce more severe infections when other medical conditions are present.
Certain medications can also cause adverse reactions for some patients. It’s important to discuss with your prescriber all medications you are currently taking, as well as any history with medical conditions even if you’ve received successful treatment for them in the past. Because of the immunosuppressant effect of Remicade, certain conditions, like hepatitis B or tuberculosis, can be reactivated due to weakened immune system response.
In some cases, a combination of medicines can prevent these secondary conditions from occurring, while others may prevent you from using Remicade entirely. Talk to your prescriber about any concerns you may have when it comes to side effects and risks related to Remicade.
Medicare Coverage for Remicade
Remicade requires a trained healthcare professional to prepare and perform each infusion. If this treatment is deemed medically necessary to treat your qualifying and covered medical condition, and you receive it in an outpatient setting, Medicare benefits may be available to help you with the cost of this medication.
When administered through an outpatient service, Medicare Part B coverage may apply to your Remicade infusions. You will still be responsible for any applicable deductibles, copayments or coinsurance. If you have Original Medicare, a supplemental insurance policy offered through a Medigap, or Medicare Supplement plan, may help lower your out-of-pocket expenses.
Generally speaking, healthcare services that come to the home to administer Remicade infusions are not likely to be covered unless Medicare’s home health benefits deem it medically necessary for a qualifying set of circumstances. Your Medicare provider can help you determine coverage availability and what your prescriber may need to prove the medical necessity.
If your Remicade infusions must be administered in combination with other prescription medications, a Part D Prescription Drug Plan or the prescription drug coverage available through a Medicare Advantage Plan may help cover these medications. Each prescription drug plan will have its own formulary, or list of covered drugs, and costs can vary.