HealingWell
Search Close Search
☰

Insurance Companies SUCK!

Support Forums
>
Ulcerative Colitis
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 7/7/2017 7:23 PM (GMT 0)
Hi all,

I haven't been here in a while as I've been in remission and doing pretty well for a couple months. BUT my company switched our insurance providers and apparently they cover barely any UC related meds.

I've been taking 2 Lialda a day and adding rectal meds here and there for maintenance. Lialda was $30 a month and enemas were only $5.

I tried to refill my prescriptions and get more enemas since I've been experiencing some symptoms in the last week and BAM. They don't cover any of it. I looked at the list of what they do cover and for UC meds they only cover Apriso and Sulfasalazine. I've been doing so well with Lialda I'm terrified to switch. I also have major problems swallowing large pills so only taking 2 Lialda a day has been do-able - I know with these other meds you have to take up to 8 a day! Nooooo!

I'm going through the whole "Prior Authorization" thing with my doctor but I've done that before and I'm not expecting Blue Cross to change it's mind and cover Lialda.

Any tips? Advice? I'm very worried.
Posted 7/7/2017 10:24 PM (GMT 0)
I guess you can't do much besides wait to see if they approve it. The only other thing you could do would be to order from another country where medication is cheaper. Even if you went that route, it would cost more than you were paying & some people aren't comfortable with ordering medication. Another negative is that it takes a while to get mail order... Apriso isn't a bad option, but it's capsules, and if you don't like lialda tablets, I feel like those would be worse & generally people take more of them.
Posted 7/7/2017 11:12 PM (GMT 0)
I have blue cross and they cover lialda, that stinks that your policy doesn't. We have a pretty fancy plan, though. Hope they come through for you!
Posted 7/8/2017 12:24 AM (GMT 0)
I take apriso and its 4 capsules a day but I was on lialda in the hospital and as I recall the tabletz were bigger than apriso. Its so stupid -- at that time the Dr wanted me on lialda but ins wouldn't cover it so we went to apriso. Now on my current plan lialda is a lower tier which usually means a lower price . you might check the manufacturer site for lialda and see if they have a patient assistance program. If they do give them a call and ask if they can help you. I am getting my apriso and uceris free from salix. It isn't their copay card assistance but the patient assistance program. Not all companies have them I also am getting Canasa from their manufacturer. My drug plan stinks and canasa is $1500 a month copay. Apriso is $300

Post Edited (FlowersGal) : 7/8/2017 8:37:37 PM (GMT-6)

Posted 7/8/2017 2:51 AM (GMT 0)
Have you tried using the Lialda Pharmacy savings card?

www.lialda.com/patient-support-program.aspx
Posted 7/8/2017 4:16 AM (GMT 0)

noodlesnoodles said...
Have you tried using the Lialda Pharmacy savings card?

www.lialda.com/patient-support-program.aspx

Yes, this is a fantastic idea. Maybe it will get your costs down!!!
Posted 7/9/2017 12:29 AM (GMT 0)
Thank you all for your responses. I will definitely look into the patient assistance program.

In the meantime, it looks like I'm sliding back into a flare and I have no rectal meds right now. The Rowasa isn't covered. Luckily the Hydrocort is but I'm still waiting on the pharmacy to get it in - Mon they said. I'm scared to up my Lialda from 2 to 4 a day because I'm basically rationing them until I know what's going on with my insurance. And to top it all off when I called my GI on Friday, the office told me my doc is no longer there! He's just gone and no one even told me so I basically don't even have a doctor right now.

Uuugghh trying not to stress and make this work but every time I go, the blood is getting worse.
Posted 7/9/2017 2:39 AM (GMT 0)
Oh man that sucks. I hope you get it all straightened out soon. Good luck!
Posted 7/9/2017 10:50 AM (GMT 0)
I wouldn't recommend rationing pills. Ask your gasteroenterologist if they have any sample bottles. I've gotten 30 day supplies of 120 lialda pills that way before.

Definitely sign up for the copay assistance card from Shire. Call them and you can sign up quickly over the phone, and your pharmacy can use it an hour afterwards. Having the physical card isn't needed, just need your number and bin, which they give you.
Posted 7/23/2017 1:52 PM (GMT 0)
I'm really surprised Blue Cross doesn't cover it. I have Blue Cross Blue Shield and even with my new plan from work this year it still was only $200 for a three month supply. I looked into the patient assist program from Lialda since my costs went up and I ended up paying $30 total for a three month supply. Definitely look into that. Good luck!
Posted 7/23/2017 10:07 PM (GMT 0)
Assuming you'll have to see a new in-network GI, try to feel this provider out RE prior-authorization support & heterogeneity of UCers' response to existing Rx meds. Hopefully, you'll get a doc who is already aware of these needs/problems, but if not, you'll have to alert him or her. I agree with your thread title, and wish you strength to pursue the med you need. Only my gastro's concern for IBDers & persistent help has enabled me to deal effectively with insurers, who love to change Rx formularies & limit our options. / Old Hat (36 yrs with left-sided UC; presently in remission taking brandname Colazal)
✚ New Topic ✚ Reply