Support and insurance FAQs
Your insurance questions answered here
- Is REMICADE® covered by my insurance plan?
- Why does insurance coverage vary so much?
- Does Medicare cover treatment with REMICADE®?
- Does Medicaid cover treatment with REMICADE®?
- I am on a managed care plan. Will my treatment with REMICADE® be covered?
- How do traditional health insurance plans provide coverage for REMICADE®?
- I called my insurance company, but I still have questions about paying for REMICADE®. Who can help?
- Are there other sources of financial help I can look into?
Is REMICADE® covered by my insurance plan?
Treatment with REMICADE® is covered by most insurance plans, as well as by Medicare and Medicaid. Just remember that coverage policies may vary by insurer, by individual, or even between plans offered by the same insurer.
Why does insurance coverage vary so much?
Your insurance coverage can vary for many different reasons, including:
- Whether your doctor is part of your health plan (eg, “in network” vs “out of network”)
- The location where you get treatment with REMICADE® (eg, doctor's office, home infusion setting, or hospital outpatient department)
- The rules for preauthorization or referral forms for visits to outpatient departments or medical specialists
If you have any questions about insurance coverage or reimbursement, you should first call your insurance company or Medicare.
Does Medicare cover treatment with REMICADE®?
Medicare carriers and the claims processors for all states cover infusions of REMICADE® in doctors' offices and hospital outpatient facilities. The traditional Medicare Fee-for-Service Program does not cover infusions of REMICADE® when they are provided by home infusion companies or retail pharmacies.
Does Medicaid cover treatment with REMICADE®?
Medicaid covers infusions of REMICADE®, but coverage may be restricted to certain treatment settings or may require precertification.
I am on a managed care plan. Will my treatment with REMICADE® be covered?
Most managed care plans—such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs)—cover treatment with REMICADE®. Managed care plans typically require that the patient share some of the cost of infusion therapies. In general, these plans are likely to require precertification and completion of referral forms for specialist care. They may also limit the choice of providers from whom you may obtain treatment.
How do traditional health insurance plans provide coverage for REMICADE®?
These plans usually cover treatment with REMICADE®. Typically, this insurance offers coverage for a wider range of services, but with a higher level of copayment than a managed care organization. Precertification or prior authorization is usually not required.
I called my insurance company, but I still have questions about paying for REMICADE®. Who can help?
If you need additional information related to medical coverage for REMICADE®—or if you have other questions or concerns—call AccessOne® at 1-888-ACCESS-1 (1-888-222-3771) for assistance.
Are there other sources of financial help I can look into?
Yes. There are many sources of public and private financial support available to people who need help paying for their medical treatment.
REMICADE® can lower your ability to fight infections. Serious and sometimes fatal events can occur. There have been reports of serious infections including tuberculosis (TB) and infections caused by bacteria, fungi, or viruses that have spread throughout the body. Lymphoma, including a fatal kind called hepatosplenic T-cell lymphoma, and other cancers have been reported in children and adults taking REMICADE®. Some people with heart failure should not take REMICADE®. Other serious side effects reported include skin cancer, hepatitis B, liver injury, blood problems, allergic reactions, nervous system problems, or lupus-like syndrome. To learn more about these and other risks, please read the Important Safety Information and the Medication Guide , and talk with your doctor.