Infusions given inpatient Medicare

[rheumlife15]

Hi all,

got a question regarding infusion and costs. I have a patient who needs Rixumab for vasculitis. After getting approved in our infusion clinic under Medicare (part B, I think) the co pay is very high.

If they were admitted to the hospital, would the infusion be covered under part A? Would this mean that the cost could be more affordable? Many thanks

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[Chemist0157]

Hi all,

got a question regarding infusion and costs. I have a patient who needs Rixumab for vasculitis. After getting approved in our infusion clinic under Medicare (part B, I think) the co pay is very high.

If they were admitted to the hospital, would the infusion be covered under part A? Would this mean that the cost could be more affordable? Many thanks

Think it depends on the facility. Where I am, rituximab is not available at all inpatient unless one demonstrates failure of other therapy (which would be difficult given the expected timeframe of improvement of failure) so default is cyclophosphamide. That would be the other wrinkle. May need to call the inpatient pharmacy for further details.

 

[rheumlife15]

Think it depends on the facility. Where I am, rituximab is not available at all inpatient unless one demonstrates failure of other therapy (which would be difficult given the expected timeframe of improvement of failure) so default is cyclophosphamide. That would be the other wrinkle. May need to call the inpatient pharmacy for further details.

Good point. At my old hospital, we gave rituximab for almost everyone walking in the door with vasculitis with lots of them being uninsured but it was a big academic center. Now that I’m dealing with mostly insured patients , I’m wondering what’s the best way to give them this expensive medicine. Cytoxan does look like it would be more widely available and a lot less expensive but don’t like long term side effects