I know. Same experience but with a biological pen. I was quite blindsided by the Medicare rules and I worked/ owned company in medical management. I pay for the best supplemental insurance and still it is a different set of rules for Medicare primary folks.

To Julie....Exactly!!!! even with a supplemental Medicare prescription plan Medicare will only pay for their approved list of medications. Yep, it's pretty upsetting knowing you worked hard all your life paid your taxes, kept your nose clean only to learn when you go on Medicare including paying for supplemental insurance riders you have to fight every inch of the way to get proper treatment...Thank you Tonda for your suggestions regarding the Orencia and Remicade and other bio's suggested. These options have been tossed around in my rheumy's office a couple of times only for all three of my rheumy's to give me a thumbs down. My primary challenge right now is any medication I take oral, injectable or infused does not cause gastric intestinal stress. I battle Gastroparesis. Was pretty sick mid spring with a gastro tube and a drop of 40 pound in 2 mos, so I think this is why the dr's are so adamant about the simponi as I had almost no side effects with it.

@A myRAteam Member - Ask your rheumy about Orencia infusions or Remicade infusions. They are both covered by Medicare ad depending on your Supplemental F insurance, you shouldn't have to pay anything. for them,

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A myRAtea...

Have been off my biologicals now for over 1.5 yrs. I was using Simponi and after the third infusion I definitely noticed a difference. Since turning 65 and on Medicare, it does not matter if you have supplemental insurance or not, medicare will not pay for my infusion. My Dr and the hospital went back and forth on this for almost 6 months and I was finally told that medicare would approved the infusion. My co payment and the cost of the infusion will be apx 2600.00 per infusion. No thanks can't afford it. Let me add I tried to get on a financial assistance program from the pharmaceuticals who make simponi but if you are on a federally funded insurance plan you cannot participate according to the company representative and the advocate at my hospital.

Check to see if Infectra has a copay card. I know enbrel, humira, and Orencia did. It took my copay with bcbs from 100 to just 5. Call their customer support!