When you receive a chronic disease diagnosis, there is a whirlwind of thoughts and questions that come to mind. Though discussing treatment options is usually the top priority, the next question is often, “How much does infusion therapy cost?”
How Much Does Infusion Therapy Cost?
While infusion therapy can be an extremely effective way to treat chronic diseases, it often comes with a high price tag due to the extensive research behind the development of these medications. Depending on the medication type and dosage, the cost of infusion therapy can range from $200 to $1,000 or more per treatment, with many patients needing multiple weekly or monthly treatments.
For perspective, a year of infusion therapy treatment can cost anywhere from a few thousand to tens of thousands of dollars. According to an analysis of rheumatoid arthritis patients, the estimated cost of RA infusion therapy per year in a hospital setting is between $36,000 and $47,000.
In addition to the manufacturer’s cost of the infusible drugs and biologics, there’s also a cost for the equipment and medical staff necessary for an infusion facility to administer the medication. Infusion costs also differ depending on the drug, infusion location, dosage, and more. These costs are passed down to insurance companies, and the uncovered remainder will become the patient’s responsibility.
Insurance Coverage for Infusion Therapy
When your insurance is considering your coverage for infusion treatments, there are two important elements they will review:
- The therapy, which is the process of administering the medication
- The medication, which is the drug prescribed to be infused
You will need a prescription from your physician before your insurance can determine coverage. Usually, insurance companies will not cover infusion therapy unless it is for a chronic illness. This may require clinical notes from your physician to support your need for the medication.
The majority of FlexCare’s patients receive some degree of insurance approval for infusion therapy because our team provides documentation that supports the need for medication. If your insurance company deems infusion therapy is not medically necessary for your treatment plan, our team may be able to work with your physician to appeal their decision.
How to Save on the Cost of Infusion Therapy
In the event your insurance company refuses to cover the cost of infusion therapy, or if you still have high out-of-pocket costs after coverage, you may be eligible for other cost-saving opportunities.
If you are looking to lower your out-of-pocket cost for infusion therapy, here are 6 ways you may be able to save.
Biologics vs Biosimilars
The difference between biologics and biosimilar drugs is minuscule. In fact, there are no clinically significant differences between biologic and biosimilar infusible medications. And in the case of interchangeable biosimilars, which go through additional testing requirements, they are interchangeable with biologics. However, unlike biologic medications, biosimilars don’t take as long to initially produce since clinical trials have already been completed on the biologics. As a result, biosimilars are generally less expensive.
For instance, Remicade® (Infliximab) is a biologic used to treat patients with Crohn’s disease, ulcerative colitis, rheumatoid and psoriatic arthritis, plaque psoriasis, and ankylosing spondylitis. Many patients with these diagnoses receive infusible biosimilars (Renflexis, Inflectra, Avsola) with comparable results.
Talk with your doctor about biosimilars as an alternative to a biologic. Depending on the drug, the cost of infusion therapy biosimilars can be around 15 to 35% less expensive than their parent biologic. Keep in mind that availability, location, insurance coverage, and your diagnosis can affect whether you are able to receive a biosimilar over a biologic.
If you have questions about your prescribed biologic, reach out to your provider.
Co-pay and Drug Assistance Programs
Participation in a co-pay or drug assistance program can save you money on out-of-pocket infusion costs. These programs are often offered through drug manufacturers, disease foundations, or other independent entities. When you use a co-pay or drug assistance card, your insurance company and medication manufacturer will pay for some or all of the co-pay.
For instance, depending on your eligibility, you may be able to pay as little as $0 per dose of KRYSTEXXA® as a member of the Horizon Commercial Co-pay Program.
These programs are often available for biologic medications that don’t have biosimilar alternatives. Visit your medications manufacturer’s website to find more information on programs and eligibility.
Disease foundations also may offer drug assistance programs and a directory of disease or drug-specific financial resources, including independent funds and financial support options. For example, The Lupus Foundation of America, Crohn’s and Colitis Foundation, and the National MS Society all provide financial resources for patients seeking fiscal support.
Remember to review the eligibility criteria before applying to a program.
Your infusion center may also offer co-pay assistance support to help cover the cost of infusion therapy. FlexCare Infusion Centers offers a Co-pay assistance program to patients who need extra support affording infusion therapy treatments. To learn more, give us a call at (405) 509-6599 or send us a message.
Site of Care Matters
Did you know that the location you receive your infusion could cost you more? Inpatient or hospital infusion centers are often more costly to patients (up to 3 to 5 times) than ambulatory (stand-alone) centers or home infusions.
According to the National Infusion Center Association, optimizing the patients’ site of care can dramatically lower costs. For example, in Magellan’s 2017 Medical Pharmacy Trend Report, hospital treatments for Remicade (infliximab) were more than double the cost of an ambulatory clinic. The savings can be even greater depending on the medication.
It’s important to discuss the site of care with your provider before receiving treatment. Your provider may be able to send your referral to a stand-alone center, like FlexCare. Our private infusion suites are designed with patient comfort in mind and include leather recliners, free Wi-Fi, and complimentary snacks and drinks. Ask your provider to send your referral to FlexCare Infusion Centers.
Make Sure You are In-Network
In-network providers or services will save you money on the cost of infusion therapy. That’s because an in-network provider or service is contracted with your insurance provider and can charge you less for care.
Patients can still receive care from out-of-network providers, but may have to pay full price—the cost difference can be significant.
Your health plan matters too: patients with an HMO plan (Health Maintenance Organization) typically won’t have any benefits with providers that are out-of-network. Patients with a PPO (Preferred Provider Organization) usually will have benefits with out-of-network providers, however, costs may still be higher than if they received care from an in-network provider.
Double-check that your insurance plan is in-network with your infusion clinic. FlexCare Infusion Centers is in-network with most major insurance plans, including BlueCross BlueShield, Cigna, and others.
Consider an FSA or HSA
Some employers offer Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) to help their employees pay for medical costs, including the cost of infusion therapy. FSAs are only offered through your employer, but you may be able to open an HSA on your own depending on your health plan.
Both plans allow you to put away pre-tax dollars that are also tax-free when withdrawn. HSA contributions grow over time and can be rolled over year-to-year, but FSA dollars don’t roll over year-to-year. It’s important to plan your expenses accordingly to use funds appropriately.
Discuss Your Financial Concerns with Your Provider
Navigating a new diagnosis can be stressful, and the last thing patients want to worry about is how they will be able to afford their medication. If you are concerned about the cost of infusion therapy, talk with your referring provider. They may be able to offer or suggest additional resources.
Do you have questions about financial assistance for infusion therapy? Our team at FlexCare Infusion Centers helps patients afford their medications. Contact a member of our team to learn more about your eligibility for financial assistance programs.
Updated April 13, 2023