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Ulcerative Colitis
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Posted 2/17/2017 7:25 PM (GMT 0)
So my insurance doesn't want to cover the lialda and wants my Dr to prescribe sulfafalazine instead unless my Dr can send them some sort of "proof" as to why the sulfafalazine wasn't used first or can't be tried.
I've been dealing with this since Monday. I just want to start getting better. I would feel much more comfortable taking the lialda while breastfeeding but I have no idea what to do. I keep calling my GI who is saying they're trying to find something to put me on, but my insurance seems to only want to cover the one drug. I'm sick of being the middle man in all these phone calls because I only know so much.
Sigh 😩
Posted 2/17/2017 7:43 PM (GMT 0)
Try asking for Mesalamine DR, a generic to Lialda. Sulfasalazine is also a generic, but a really old ulcerative colitis medication that causes a lot more incidence of side effects due to the Sulfa component. Newer medications are much safer.
Posted 2/17/2017 7:47 PM (GMT 0)
I'm not sure my insurance will cover that either, should I call them and ask? They seem to be insisting on the sulfafalazine or medical documentation proving why I am not taking it for other meds to be considered.
Posted 2/17/2017 7:57 PM (GMT 0)
Your generic equivalents are Mesalamine DR (mesalamine delayed-release-coated like Lialda). Other similar but much, much older generic UC meds are Colazal (Balsalazide disodium), or Dipentum/Olsalazine, similar but they are more complex molecules without a delayed-release coating that are broken down by gut bacteria into mesalamine and a byproduct. In sulfasalazine that byproduct is sulfa an allergen for some.

I'd call and see what is on their formulary list. All of the meds I listed aren't once a day though, Lialda is. I take Mesalamine DR once a day though; better than forgetting multiple times a day :-p
Posted 2/17/2017 9:34 PM (GMT 0)
I'm in the same situation. My insurance wouldn't cover Lialda and I'd have to pay out of pocket until I met my deductible. It was going to cost me around $1000 for a 3 month supply. I begged my dr. to put me on something else and she prescribed sulfafalazine, but it makes me so nauseous that I'm taking 1 pill a day when I'm apparently supposed to be taking 6 (2 3x per day). The plus side is I'm having no UC symptoms. Same BM as when I was on Lialda and no blood. The only thing I've noticed more of is stomach discomfort, which leads me to take another pill (blanking on the name) but that seems to help within a half hour or so. I'm supposed to talk to my dr. on Monday to discuss the situation. Insurance sucks.
Posted 2/18/2017 1:00 AM (GMT 0)

iPoop said...
Try asking for Mesalamine DR, a generic to Lialda. Sulfasalazine is also a generic, but a really old ulcerative colitis medication that causes a lot more incidence of side effects due to the Sulfa component. Newer medications are much safer.

Exactly right. Sulfasalazine is an older med that's as effective, or even slightly more effective, than the mesalamines - but its side effect risk profile is much, much worse. For that reason it's not used so much any more.

There are several different mesalamines, many brand-name, and now even generics. Any reasonable insurance's pharmacy formulary will include at least one of the mesalamines. If not, that insurance needs to be reported to your state's insurance regulator(s). Unacceptable.

Marciac12, same story - work with your doctor to find a mesalamine that your insurance covers. If they don't cover any of them, file a complaint.
Posted 2/18/2017 3:27 AM (GMT 0)
C.differently...see if you can find your insurance company's formulary online. I've been able to find several formularies online for my insurance company. If you can find it, it will give you insight as to why they are pushing sulfasalazine and what exceptions are in place.
Posted 2/21/2017 2:31 PM (GMT 0)

marciac12 said...
I'm in the same situation. My insurance wouldn't cover Lialda and I'd have to pay out of pocket until I met my deductible. It was going to cost me around $1000 for a 3 month supply. I begged my dr. to put me on something else and she prescribed sulfafalazine, but it makes me so nauseous that I'm taking 1 pill a day when I'm apparently supposed to be taking 6 (2 3x per day). The plus side is I'm having no UC symptoms. Same BM as when I was on Lialda and no blood. The only thing I've noticed more of is stomach discomfort, which leads me to take another pill (blanking on the name) but that seems to help within a half hour or so. I'm supposed to talk to my dr. on Monday to discuss the situation. Insurance sucks.

You need to slow down with increasing the dose. Increase the dose to recommended over the period of a month. Until then keep steroid and mesalamine enema at hand. I had the same issue, along with a severe headache, but increasing the dose slowly helped. No issues now.
Posted 2/22/2017 3:54 PM (GMT 0)
I'm going through the same thing right now. See if your doctor can submit a prior authorization to the insurance company. And if it gets denied like mine did, try to apply for the patient assistance program with Shire, who makes Lialda. https://www.shire.com/patients/patient-services/shire-cares
It takes awhile to hear back, I submitted mine 2 weeks ago and still haven't heard anything back, but it's worth a shot.
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