ULCERATIVE COLITIS, MEDICARE, PRESCRIPTION DRUG COST IN US

im in a very expensive prescription dilemma with medicare.
i currently take Lialda or Apriso to control my colitis.
Both work for me, and for the better part keep me out a flare.
im going broke though.
The US donut hole for Medicare patients is reached very quickly.
For me, I reach the donut hole in Feb.
there are NO generic alternatives in the US.
i am forced to pay $400.00 a month for one 30 day supply for one
prescrition.
i live in San Diego, close to the Mexican border and was thinking I would pursue a visit to a GI and see if I could get an equivalent in Mexico. i dont even know if they have a MESALAMINE ORAL DRUG on a pattented drug here in the US
Is any one out there from Canada, Mexico, USA taking this drug while on Medicare.
when i was working and had work insurance i only had to pay $10.00 for a 30 day supply.
On Medicare you cannot use discount cards!
the pharmaceutical companies and Medicare have an agreement to ban the middle class from receiving a discount.
if you happen to be poor, you can get the drugs for far less otherwise you become a declining financial victim.
we are forced to look for alternatives like I am....
here BEGGING ANYONE with some suggestions to help me.
so I appreciate any advise from those in Usa,Canada, Mexico as to what you are paying that is less than I,under these circumstances
hope you all stay as healthy as possible!

thanks DB
Is Asacol a mesalamine like Apriso and Lialda?
Have you tried all 3 for maintenance?
never tried balsalazide...I will look it up now...lI also take an awsome probiotic

I have always been denied whenever i give these pharmacies coupons
but I can call Costco and ask them about Good RX/ Medicare
I already have a message into my Dr. through Follow My Health
about
the drugs you mentioned
i take 4 Lialda a day.
Two in morning, 2 in evening.
I know we are all different but what is your dosage of balsalazide?
At this point $300.00 every 3 months sounds like heaven!
considering I am paying 1280.00 for 3 months at present

I take the max, 9 capsules a day, so you'll be hauling out a ton of pills from the pharm.

If you have a smartphone, tablet you can download the GoodRX app or just go online to the GoodRX and you can plug in the drug name and it will give locations of pharmacies around you and how much, the prices will vary, so a cheaper price than Costco might pop up. I don't know what your dosage will be, so I'd just high ball it and put in 810 capsules for the quantity, that's how many I get for 3 months. All of those places listed may not take the coupon but Costco did. Costco also offers RX discounts for members but I don't think you need one to use GoodRX. Oh, and on GoodRX, they don't name Costco, they just call it Warehouse retail store but it's Costco.

I'm thinking you can just take prescription to Costco and just pay for it, like you have no Medicare, no insurance? Is that kosher? I'm mean, you are paying outright, so not like you are getting a break or frauding the gov. I dunno though. Good luck, hope you can catch a price break.

Yes, so brilliant, make it illegal for our country to negotiate drug prices with big pharma. 😡

Well, the donut hole Medicare Rx Drug Plan was an invention of the W. Bush regime, which did not want to limit profits for Big Pharma. what can you do? I would not advise you to try sulfasalazine just because it's cheaper than more recent meds; it can cause many side effects, as I know from having to take it when 1st DXed with UC decades back!!!!! You also have to be realistic and FORGET the $10/mo. co-pay for med that you had while working. (Before my retirement I had ZERO co-pay.) Now under Medicare I pay nearly as much as you for 90-day supply which I am obliged to get via mail delivery from Expressscripts. I would not advise you to change your 5-ASA to Balsalazide if you have pancolitis, either; it is optimum for left-sided UC. Be thankful if Lialda/Apriso help you-- a flare in the senior yrs is no fun. / Old Hat (35 yrs with left-sided UC; presently in remission taking brandname Colazal)

If you have pancolitis Asacol might work for you, but there have been problems with it in the U.S. in recent yrs, as members have posted here. In short, it was changed to Delzicol, with a new coating, and the pharma then produced a new higher dosage Asacol HD. Recently I met a senior female at my local UC support group, who commented that she did fine on original Asacol, but has some problems with both of its successors! I myself did not get any relief from Asacol yrs back, and it turned out that at the time it was RXed for me, doctors did not realize a patient must have colon acidity (pH) level 7 or higher for it to work effectively against UC inflammation! (Apriso requires level 6.) So-- I'm taking the only 5-ASA that works for me; it's a brandname, but I don't want to risk complications/shortfall from the 2 generic versions of Balsalazide sold in U.S. I understand your predicament completely!!!!!! My saving grace has been that my gastroenterologist certified me for brandname when I 1st joined Medicare & my employer-related retiree Rx supplement lets me access a formulary listing my med in Tier 3. Of course this latter provision can still change! A Canadian pharma bought my U.S. producer in 2014 & already tripled the market price of Colazal since then. Most of us go thru Hell with insurance issues at one or another time in our UC careers. As I recall, a senior member of this forum had some good luck about 6 mo. back trying a Walmart pharmacy in PA-- if that's a provider in your area, maybe you can check Rx prices there. Best wishes!!!!! / Old Hat (35 yrs with left-sided UC; presently in remission taking brandname Colazal)

Many of the private cost reduction programs and most manufacturers assistance programs are not applicable with Medicare. For reasons which I can't entirely understand, people on any sort of government insurance are specifically excluded. Even though Medicare doesn't pay for my prescriptions (I have a terrific supplement plan from my former employer), I still can't use any of those price breaks.

Thanks Missjoy
Canasa alone does not work for me, and the doctor seems unable to lower the tier on Lialda or Apriso...still working on it though!

what I meant is that doctor cannot lower the tier.
it would be so great if he could

you reach the gap quickly because the gap is based on the retail price of the drug which in my case is about $1700 retail Lialda
(might be a little lower now, as ea year to the expiration of the patent date, the drug's retail price lowers slightly)
then you must reach the approx $4500.00 out of pocket before you take advantage of catastrophic coverage.
Therefore
The math works very well for the pharmaceuticals on patented
drugs that have no generic.
Im sure our elected officials insurances cover these drugs at MAYBE
a $5.00 co pay for life?...

pltt19: I have moaned on the forum too about costs. I am still not used to paying $400 for an Rx that used to be $5 or $10.

I have tried balsalazide. It might save you something but I'm not sure how much. It started out at a higher tier with higher co-pay and then the cost went down compared to Lialda in the donut hole, but I got tired of the 9 pills a day and wasn't sure if it helped as much as Lialda. Do the math on costs.

I am lucky (?) that I was able to spend my way into catastrophic coverage this year. I call it "the promised land". Still not cheap--Lialda is around $60 and 3 months of Canasa is around $250 (Canasa would be $2000 otherwise; I am stunned.) So one way to go is to get into catastrophic at the beginning of the year and maybe get your MD to prescribe a little extra to carry you into the next year.

I researched Canada but the cost was still high and their less expensive drugs are made in questionable countries.

If anyone knows who is paying attention to this I will rattle their cage. Hep-C is a poster child at $1000 a pill, but for that you at least expect a cure. Epi-pen is another headline maker but use is rare. Who is paying attention to IBD that goes on forever?

It hurts when the MD hands out savings cards which never apply to Medicare. $25 for Uceris; $35 for Canasa. Does anyone understand the huge price gaps? There must be all kinds of underhanded politics going on, but all I'm looking for are ways to get some attention and fixes.

Sorry I have not found easy answers for you. The bottom line is that you can do a few things, like balsalizide, but there will still be a big gap between what Medicare (beneficiaries they call us) and others pay. We don't have Kaiser or other HMO's where I live but I know that Lialda only costs my Kaiser friend $5-10 (he is 64, not Medicare). See you under the bridge!

Naturalcurl
I have reached a happy medium for now.
After lots of research and experimental measures here is where I am.
I did try the Balsalazide. Dosage was 750 mg 8 pills a day.
By day 3 i started getting that sickening feeling that I was close to a flare. You know the symptoms, diarhehia, weird stomach and rectal noises. Cramps....
i reacted quickly, going right back to Apriso.
The colon settled down and was appeased
I called the doctor and asked if I could combine. He said yes.
I went back to the drawing board combined the mesalamine, and started again. It worked for me!
Between the 2 meds I can now survive physically and financially.
Now if this should change, thanks to your advise I know have even
more options.
Im also looking for a GI who will give samples.
I really like my GI but his group is no longer giving samples for UC.
Their group is afraid that an unhappy patient may come back and sue them if we have reactions to the samples ( gotta love California!)
I could lease a Mercedes monthly for what we have to pay out for one monthly prescription.
A person really needs to be creative with this! Its ridiculous!
Thanks so much for the great info!