{"id":630098,"date":"2024-10-15T11:53:38","date_gmt":"2024-10-15T15:53:38","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=630098"},"modified":"2026-06-04T18:04:16","modified_gmt":"2026-06-04T22:04:16","slug":"does-blue-cross-blue-shield-cover-remicade","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-blue-cross-blue-shield-cover-remicade\/","title":{"rendered":"Does Blue Cross Blue Shield cover Remicade?"},"content":{"rendered":"

Whether fighting infections, healing the body, or protecting it from germs, our immune systems have a lot of responsibility. But they can sometimes overreact, causing inflammatory diseases like rheumatoid arthritis, psoriatic arthritis, Crohn\u2019s disease, ulcerative colitis, and plaque psoriasis. <\/span>Remicade<\/span><\/a> (infliximab) is a tumor necrosis factor (TNF) blocker that\u2019s <\/span>approved to treat these conditions<\/span><\/a>. But its effectiveness and versatility come at a price that leaves many patients hoping for health insurance coverage.<\/span><\/p>\n

If you have a Blue Cross Blue Shield health plan, it might cover Remicade. But not all plans do, and some have restrictions and other requirements. We\u2019ve got details on all that and more below.<\/span><\/p>\n

Does Blue Cross Blue Shield cover Remicade?<\/span><\/h2>\n

Mohamed Noureldin, MD<\/span><\/a>, gastroenterologist and founder of <\/span>Scribe Medica<\/span><\/a>, says Blue Cross Blue Shield (BCBS) plans often cover Remicade. However, not every BCBS policy provides coverage. It depends on your plan and the condition you\u2019re treating.<\/span><\/p>\n

The Blue Cross and Blue Shield Association doesn\u2019t just have many different plans; it has <\/span>many different companies<\/span><\/a>. Most states have their own independent licensees of the Blue Cross, and each one has its own range of plans. While many will cover Remicade, these plans vary in how and when they\u2019ll cover it.<\/span><\/p>\n

If your private insurance covers Remicade, there might be some caveats involved. Specifically, it might have <\/span>prior authorization requirements<\/span><\/a>. Before issuing coverage, the insurance provider typically wants to confirm that Remicade is medically necessary for you and that you\u2019re using it to treat a condition the Food and Drug Administration (FDA) has approved it to treat. \u201cThe requirement in my field of gastroenterology is a diagnosis of <\/span>ulcerative colitis<\/span><\/a> or Crohn’s disease,\u201d Dr. Noureldin says.<\/span><\/p>\n

In some cases, however, it might mean your healthcare provider needs to submit documentation of symptoms, specialist visits, or other information to BCBS. In others, you might need to try other medications first, which is a process called <\/span>step therapy<\/span><\/a>.<\/span><\/p>\n

If you have a BCBS Medicare plan, <\/span>it might cover Remicade<\/span><\/a> under Part B since it is administered intravenously (through a vein) by a healthcare provider in an outpatient setting. You\u2019ll be responsible for your Part B deductible, copays, and coinsurance. After you meet your deductible, you\u2019ll typically be responsible for 20% of the Medicare-approved amount for Remicade, but the total amount can change as the drug\u2019s price changes.\u00a0<\/span><\/p>\n

What about Remicade biosimilars?<\/span><\/h3>\n

Remicade is a biologic drug, which means it\u2019s created out of human, animal, or microorganism cells rather than dead or synthetic substances. <\/span>Biosimilar drugs are extremely similar<\/span><\/a> (although not exact replicas) to their biologic counterparts in the same way that generic drugs are similar to their brand-name counterparts. For example, Dr. Noureldin says, \u201cInflectra is an equally good alternative for treatment of ulcerative colitis or Crohn’s disease.\u201d These drugs work the same way, and like generic drugs, they\u2019re often cheaper than their reference medications, so some insurance providers might prefer them over brand-name biologics.<\/span><\/p>\n

If your BCBS plan lists Remicade as a nonpreferred drug, it might provide better coverage for a <\/span>Remicade biosimilar<\/span><\/a> like Inflectra, Avsola, or Renflexis. You\u2019d essentially be getting the same drug, but for significantly less money.<\/span><\/p>\n

How much does Remicade cost?<\/span><\/h2>\n

Developing biologic drugs is an expensive and time-consuming process, so they <\/span>can be pricier than other drugs<\/span><\/a>, and Remicade is no exception. Since healthcare providers determine the dosage based on weight and administer it in the office, it\u2019s difficult to pinpoint a specific price, but without insurance, <\/span>it typically costs around $4,000\u2013$7,000<\/span><\/a> every eight weeks.<\/span><\/p>\n

Fortunately, insurance coverage, patient assistance programs, and other savings options can help people avoid paying that full out-of-pocket cost.<\/span><\/p>\n

How much does Remicade cost with Blue Cross Blue Shield?<\/span><\/h3>\n

Even if your BCBS plan covers Remicade, that doesn\u2019t necessarily mean you\u2019ll get your medication for free. And the out-of-pocket costs you end up paying depend on your particular plan\u2019s details.<\/span><\/p>\n

Every health insurance plan has a formulary (a list of drugs covered by a plan) that shows its cost-sharing policies for every covered medication. These policies determine how much of the price the company will cover and how much the patient has to pay out of pocket. The patient\u2019s portion usually takes the form of coinsurance, which is the percentage of drug costs you have to pay after meeting your deductible, or copays, which are set amounts you pay when you receive a medication or medical service.<\/span><\/p>\n

Insurance providers organize covered drugs into tiers. In most cases, lower-tier drugs have fewer out-of-pocket costs, while higher-tier drugs come with higher copays and coinsurance. The number of tiers can vary by plan, but tier 1 is typically reserved for generic drugs, while brand-name and specialty drugs occupy the higher tiers. As a specialty drug\u2014one that requires special handling or administration\u2014Remicade is usually in one of the highest tiers.<\/span><\/p>\n

How to check whether your Blue Cross Blue Shield plan covers Remicade\u00a0<\/span><\/h2>\n

Everything you need to know is in your plan\u2019s formulary, and you can typically find the formulary on your BCBS licensee\u2019s website. For example, if you have a plan from Blue Cross Blue Shield of Texas, you can go to its website and click the \u201cPrescription Drugs\u201d tab, then select \u201cPrescription Drug Lists.\u201d From there, just find the list for your plan and scroll down until you find Remicade.<\/span><\/p>\n

Not every BCBS website has a Prescription Drugs tab. Some keep their formularies in their “Resources\u201d section instead. Or, you can search for \u201cBlue Cross Blue Shield formularies [state name]\u201d on Google. You can also call your BCBS company directly to get the information from a customer service representative.<\/span><\/p>\n

How to save on Remicade<\/span><\/h2>\n

Some people might not have insurance coverage for Remicade. Others might have coverage, but not as much as they\u2019d like. Either way, there are other ways to make Remicade more affordable. They include:<\/span><\/p>\n