Posted 12/9/2013 4:31 AM (GMT 0)
"We evaluate medications based on their total value, including how much your medication works and how much it costs. When several medications work the same way we may choose to not cover the higher cost option. The decision to not cover a medication and provide you with lower-cost options helps prevents an increase in premiums while also lowering overall healthcare costs for you and your employer....
You and your doctor make decisions about your prescription medications, so we encourage you to discuss the following lower-cost options hat may also treat your condition"
At the moment I have a months worth of my Pentasa left, and there is a three month prescription being mailed out this week. After the 1st of the year my insurance will no longer cover Pentasa. Personally I think it is a load of crap that they claim they base it upon the value of how the medication works and how much it costs. When they do not understand how it affects me, different medicines are used on different people for different reasons. Some prescriptions work for some people, while others do not work the same way. I was diagnosed in 2008 and started a regimen of Entocort and Pentasa which put me into remission. I was completely asymptomatic. Fast forward to 2011, my parents insurance stopped covering Pentasa. I was in remission and feeling well. The GI did not want to switch to a different medication, and based on my health we just went off Pentasa entirely. I went a full year without any issues. However, last year I flared up after recovering from c.diff. I had to resume taking Pentasa and a regimen of prednisone to get things under control. Luckily at that point in time I had my own health insurance to cover my medication once again. After resuming Pentasa everything was A-Okay. However, I had a recurrence of c.diff again later that year. My GI said the flare had nothing to do with my c.diff recurrence, but decided it was time to start a stronger therapy because of the issues I was having. At the beginning of this year I started taking 6-MP. I had some ups and downs getting acclimated to the new drug, but it improved upon every aspect of life and I felt normal (as normal could be for a crohnie). I have not had any trouble since starting the new 6MP treatment in combination with my pentasa. However, this news from the insurance company has me severely depressed, complied with work stress, and I have no idea what to do. I cannot afford to pay $800 a month for a prescription. I started reading articles too on how Pentasa's effectiveness has been questioned. However, I have never had any side effects from the drug and it has treated my symptoms. Then I started reading other articles and posts about how pentasa and similar drugs are used to treat the symptoms, but in the case of Crohn's the underlying inflammation is not being treated properly. My doctor never ordered a fecal calprotectin test to see how my inflammation was at any point in treatment. Beyond my regular checkup, annual bloodwork, and my monthly bloodwork for 6MP monitoring there is not much going on. My mind is spiraling right now and I feel like I'm in a whirlwind of emotion. Do I need to even be on pentasa with 6mp?
Should I go to another treatment option, when my GI never wanted to because of the effectiveness of pentasa?
What should I do?
The insurance company isn't going to change their decision, and to my knowledge I have no way to change that. I do not know what I should or should not do. I just need some help and don't even know where to start. My biggest fear is having to start a new different medication and getting a plethora of side effects. I was a wreck when I started 6-MP until I was able to adjust to it, and a proper dosage was worked out. I'm really just lost at the moment and need some feedback.