Insurance Agent Forum

[Newby]

I need to know for sure if Humira is covered under Medicare Part B. It used to be injected in the doctor's office but now it is self injected at home.

What about Remicade which is given as an IV in a medical facility.

Where can I research the Medicare Part B covered drugs?

[insurance0707]

You can go to medicare's website or you can google does Medicare Part B cover Humira. Googling has helped me many times to find the answer fast.

[patch36]

I googled humira and medicare and part b and 2008 and came up with lots of info. For instance:

Abbott Lab's statement regarding the CMS announcement on medicare demonstration project for self-injectable drugs

[MedSuppPro]

Watch dates of google search results as June 2004 is pre PartD. Since PartD -- no more free HUMIRA. Good luck finding a PartD plan that works for HUMIRA.

[patch36]

Humira is listed in the forumularies. PA and QL, as is Remicade.

That is why I included the 2008 in my search. The Humira and Remicade seem to both be Part B covered if for a medicare approved treatment and done in a Drs office or Hospital.

[insurance0707]

Here's another great program...Humira has a patient assistance program where you may be able to get it for free. There is another program listed that looks like it's disease based for Cronans (however you spell it) where you may be able to get it for free due to the health condition. here's the link...

Program

[MedSuppPro]

Patches36: It may be that you Googled ... + 2008. However, your article is dated 2004. This means it is 4 years old. A lot of Medicare rules have happened since then.

insurance0707: I have not had any sucsess with HUMIRA + PartD + Pharmaceutical Assistance Program. I also don't see this drug adminitered in a clinics neither.

[patch36]

oops. thanks.

[Newby]

I guess from reading this page from the Remicade web site (updated 01/22/2008) I can take from this that it is covered by Medicare Part B Plus a Med Sup Plan D would cover the bal after the deductible?
Remicade

[patch36]

In the formulary I read it is covered by Part D, but with PA (Prior Authorization). So, there are hoops to jump through.

[Newby]

Originally Posted by patch36

In the formulary I read it is covered by Part D, but with PA (Prior Authorization). So, there are hoops to jump through.

I need you to dumb that down for me a little bit. Does that mean it is no longer covered by part B? Where can I read this myself? Is it on Medicare's website? Is there a link?

[patch36]

That is from the Humana Drug Formulary. Every PDP company has a formulary and I have not looked in any others to confirm if they also cover the drugs and have that policy. Prior Authorization means the pharmacy and the Dr will have to get involved with the insurer.

Whether a drug is covered by a PDP or not has nothing to do with Part B, which includes Hospitial and Dr administered Drugs.

Call a Dr. office and hospital billing department and ask them about part B coverage for Remicade and Humira.

Google, search Medicare.gov, ect.

[insurance0707]

patch is right. The doctor's office prescribing the medication will usually know if this medication is covered under Part D or Part B because they're the one's usually doing the billing

[Newby]

The doctor's office didn't give her a definite answer.

I called the drug manufacturer today. They said it is still covered under Medicare part B if her arthritis is one of the listed types that it is approved for. I am going to have the doctors office call them and discuss her exact condition to get the answer straight from the source. It appears like it will be covered.

Thanks everyone for their help. Some of this can get confusing.

[patch36]

Humira and Remicade are both used for off label and experimental treatments and this will affect whether the PDP Part D or Part B will cover them. You are on the right track.

[retread]

Originally Posted by Newby

I need you to dumb that down for me a little bit. Does that mean it is no longer covered by part B? Where can I read this myself? Is it on Medicare's website? Is there a link?

Some drugs that are on Part D formularys may be administered in the doctor's office. When this is done, they are considered Part B benefits. This can be a two-edged sword, but in many cases can save the client some big bucks for hi $ drugs that can be administered by IV or injection.

Also, I tried without success to get Medicare to give me an answer on some specific Part B drugs. They just drive you around in circles and won't respond to your question directly. Best advice is get the info from the doctor's office.