Insurance no longer covers Colazal - ideas??

I’ve been getting the brand name of Colazal for I don’t know how long, maybe 10 years?  I’ve tried 2 of the generics and both of them gave me an increase in UC symptoms (not to mention one of them left a nice yellow, powdery residue all over everything it touched).  My insurance company (UnitedHeathcare) has now found a way to get around my insurance plan and is now all of a sudden (midyear through my plan) decided to charge a ‘product selection fee’ of $1600 for a 3 month supply.  That is crazy!  I can file an appeal as to why I need it, but I am pretty sure that will get rejected. Not to mention I’ll be out of my current bottle of pills before they even review it anyway.

 

So what do all of you Colazal users suggest? Is there a generic that is least likely to cause issues? I can’t remember the one I tried. I know one of them was the generic by Roxanne Pharmaceuticals.  Or is it better to just call my doctor and try another similar drug, maybe of the newer ones?  Of course then I’ll be getting a brand name for sure and UnitedHealthcare will end up paying way more for that new drug than they were paying for the Colazal. But insurance companies aren’t too smart!

 

I should also say I've been doing very well on Colazal. In total remission, no issues, feeling good.  I have left-sided UC. 

 

Thanks for any advice anybody can give!  I’m in a bit of a rush to figure out what to do now

I've written up an appeal to fax to UnitedHealthcare. I'm also thinking of writing my state senator and asking if insurance companies can even charge this fee? It definitely seems like a made up fee to me.
I already have preauthorization from my doctor to get the brand name as 'medically necessary', and the pharmacy submits it with that code too. But the insurance company said even with that, they now charge this 'fee'. So just seems like a way for them to get out of paying for a brand name even if you have doctor authorization for it.

Thanks mbills. I likely don't qualify due to my income level.

I think this is more of a prinicple thing for me. I do not want to spend $1600 every 3 months when my drugs should be free after I meet my deductible. I'm just so sick of the insurance company only being concerned with their profit over helping patients.

I did a quick search and couldn't get the Walmart price, but I can call them and find out. I assume that is price without insurance? Going through my insurance would just get that huge fee added on for me again. If anything, I suppose I could just pick up one month, without insurance, at Walmart while I see if I can get it appealed. But long term it won't be feasible so I'll have to figure out another drug to take if I can no longer get this one.

Hopefully that won't be the case as that means the insurance company wins - they would have gotten me to stop taking the medication they don't want to pay for.

I really feel for you guys in the US with the whole insurance thing. It sounds like a nightmare. I am lucky to have a public health system in my country that funds everything including biologics. Phew.

I wouldn't trust any figures United is giving you. All meds, including generics, have steadily grown more expensive & Senator Bernie Sanders (VT) frequently speaks out on pharma's price-gouging & tries to get Congress to focus on the issue. RE the specifics of your situation, you could contact the Jennifer Jaff Foundation thru their Website (formerly Advocacy for Patients with Chronic Illness) to ask for advice on dealing with it-- because their founder helped to get Colazal restored to production in 2012 after Salix suddenly halted its manufacture late in 2011. / Old Hat (34 yrs with left-sided UC; presently in remission taking brandname Colazal) P.S. Colazal originally retailed close to $800/280 caps in 2002-3.

Just got UHC and they are the worst. Had to switch from delzicol to Colazal generic. So far working but who knows. I realize that they are trying to save money but they are doing it at the expense of people's health. Tried the appeal process and going to State Representative and onto a Senator. Nothing.

I sent a note to the Jennifer Jaff Foundation and to our state senator (Amy Klobuchar, who is big on health issues). Not sure if anything will come out of those but it's worth a try! I'm just so sick of finally feeling great and then either insurance or the drug company decide too bad, so sad no medication for you. Neither of these companies are interested in actually helping patients. They are only interested in their bottom-line.

Funny Minnesota doesn't allow for-profit health insurance companies to operate in our state. But UHC gets around it by being the 'managing' insurer and having our primary be a non-profit that operates here. They try to pass it off as a great deal as we get 2 insurance networks, but really it's not. UHC is one of the worst insurance companies I've ever had, I've had nothing but issues with them.

Sadly, at this point I’d be happy to pay $600 for 3 months of Colazal. That is much cheaper than my $600 copay + the $1200 ‘Product Selection fee’ UHC wants to charge me, putting my 3 month cost over $2000. I really don’t want to mess with how good I feel now. I have a ‘normal’ life now, other than some usual IBS symptoms that probably come more from what I eat now and then rather than UC. I’m even thinking of lowering my mesalamine enema dose to every other day and then go from there. I think I’m going to go the Walmart route as well, using the coupon that was on that site. So sad that we have to forgo using our insurance benefits and actually go out and search for better ‘deals’ online. Why do we pay for health insurance if it’s cheaper just to go off on our own and get the drugs ourselves?

UHC will be paying for my expensive colonoscopy this year as I get one every other year. And I get it done at Mayo, with anesthesia, so it isn’t cheap. I wonder when they will decide they no longer want to pay for all of that? They already started a new rule this year where if we get any sort of scans (x-rays, CT, MRI) we cannot get it in a hospital or clinic - it has to be at one of those off-site, non clinic affiliated places that just do imaging, the ones that you find in strip malls. So even if you are in the clinic and they need to run tests, too bad. You have to say 'sorry can you send this order over to one of those cheap, imaging shops so I can go there and get it done?'. Their cost cutting is really getting out of control.

After more investigation, if I just come out and pay the $2300 for this 3 month supply, I will meet my out of pocket max for the year. I called and after much investigation on their end, they told me I will not have to pay the 'Product Selection Fee' again as that is part of my out of pocket max. So for the rest of the year I'd be paying nothing for the colazal (and any other drug or procedure I have done - and I have my colonoscopy this year). So I may just go this route. Just haven't decided if I should pick up 1 month at a time now to spread the cost out or just suck it up and get the 3 months. What a pain! And I sure hope they are right about this fee not being charged again. They said they ran a test claim through to see if it would get charged and it didn't. We shall see in 3 months....

I might go with that Walmart deal..I don't take 9 a day, only when flaring. 6 right now..only 4 when im in remission...i don't know whats going now. I was taking Nopal juice, ran out and im having some symptoms come back, unreal.


Walmart
270 capsules
$416.41

Canadian pharmacies don't carry Salix brand Colazal. Its a UK based company called Almiral Limited and they do not stock it..at least the 2 or 3 Canadian pharmacies i spoke with..They order it, comes from UK goes through customs etc. to get into the states and then to the user.

CC in PA-- I know that Salix wants to market a higher-powered form of Colazal under different name. They were careless with patent for the original brandname so they want in on the Asacol HD & Lialda game, fewer caps daily but higher potency (also higher cost). You are right about reason for cynicism. BTW, my Colazal RX processes thru Expressscripts so I phoned them today to inquire about my co-pay, which is doubling on 90-day supply brandname. (Tier 3, non-preferred med) They didn't give me the blarney that United spouted to MNBeachgal, though. More like: we know you really need this med so we'll politely bleed you. They should actually give me a lifetime discount for being in Phase II clinical trial for brandname CZ back in 2002! / Old Hat (34 yrs with left-sided UC; presently in remission taking brandname Colazal)