I’m still waiting for the insurance company to decide whether they’ll pay for me to go on Remicade.
The medical review unit’s most recent update to my file seems to indicate they think I have Rheumatoid Arthritis. Can it be possible that they don’t know my diagnosis???
On Wednesday they added a note to my file that they’re unable to complete the review until they know whether I’m either on Methotrexate or can’t tolerate it. This is what their Remicade policy says about Crohn’s and RA:
Biologic Response Modifiers (BRMs) when utilized for the treatment of Rheumatoid Arthritis (RA) and other Chronic Inflammatory Diseases may be considered medically necessary for the specific indications as noted:
Infliximab (Remicade)
For the reduction of the signs and symptoms, and inducing and maintaining clinical remission in adult and pediatric patients (six to seventeen years old) with moderately to severely active Crohn’s disease, who have had an inadequate response to conventional therapy.
In combination with methotrexate, for use in the reduction of signs and symptoms, inhibiting the progression of structural damage, and improving physical function of patients with moderately to severely active rheumatoid arthritis (RA). Exception: Infliximab (Remicade) used alone for the reduction of signs and symptoms of RA is allowed as an off-label use for those patients who cannot tolerate Methotrexate.
It doesn’t make sense that they’re specifically asking about methotrexate, unless they think I have RA, not Crohn’s.
They take their time communicating back to me and/or my doctor’s office (even though my doctor wants me on Remicade asap for health reasons). This note was added to the file on Wednesday but nothing had been sent out as of Friday when I spoke to them. They did promise to fax the methotrexate question to my doctor’s office by the end of the day Friday. I hope they have so my doctor’s office has something to respond to, to move this along.