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Fidelis and Remicade approval

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Crohn's Disease
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Posted 5/20/2019 3:12 PM (GMT -5)
Does anyone have Fidelis insurance? If so, have you successfully gotten them to approve Remicade? I've been on Remicade for over a decade but recently switched to Fidelis insurance. They are denying coverage for Remicade because I haven't tried any biosimilars. The biosimilars didn't exist when I started Remicade, so now they want to me to risk my health and try something unproven for me.
Posted 5/20/2019 4:14 PM (GMT -5)
Remicade is usually the first med in step therapy listings now so this is odd. I would get a copy of their step therapy requirements. Ask them for it specific to your condition and location of disease. Also, advise them that you have been on Remicade for xx period of time with success and plan to have your physician submit a request to move to this step.

Biosimilars are too new...but they may provide the same treatment levels (even our docs would not know without trying them on us). They are looking for lower costs at Fidelis I am sure. Contact a Nurse Case manager and tell them the above...you may not have to get the doc to write documentation if the RN agrees with your call.

Good Luck!
Posted 5/20/2019 5:19 PM (GMT -5)
Hello & welcome to Healing Well. We've had some members that has been moved to Inflectra with good results. If this is one of the medications they will authorize, this is the one I would agree to. The members were scared too because Remicade was working, however, they have done well on it.

Good luck.
Posted 6/5/2019 12:08 PM (GMT -5)
Fidelis is the worst. They have denied my doctors appeal 3 times. Now we are doing a external appeal with the state. I've been on Remicade for over 10 years. No other carrier has ever given me a problem. Biosimilars are not a replacement for the Biologics.
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