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Ask the Rheumatologist: Latest Answer

Q:

Ammar from Alberta asks: Biologics are expensive!  How do I make sure the cost is covered?

A:

Biologics are expensive!  They can range from $10,000 to $25,000 per year.  No one can afford that, which is why having insurance coverage for these medications is important.  Most insurance plans have rules which must be followed to have these medications covered.  Most of these rules are reasonable.  For instance, for rheumatology problems, biologics must be prescribed by a rheumatologist.  You must have a disease that we know is treatable by a biologic.  You must have tried other medications first which we know may work as well (e.g. methotrexate) before trying a biologic.  And finally, we must show that the condition has improved on a biologic.  Working with your rheumatologist, there is nearly always a solution to finding funding for biologics.  If you are having troubles, make sure your rheumatologist knows.

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