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Your drug coverage will change- BCBS

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Ulcerative Colitis
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Posted 11/23/2019 2:15 AM (GMT 0)
So... Florida Blue just sent me a new a list of the drugs they wont cover any more (approximately 200). I see quite a few IBD drugs being completely excluded from coverage; Asacol HD, Entocort, Canasa, Uceris Foam, pentasa. Looks like they will only cover Generic Extended Release Mesalamine & Enema. Opinions?
Posted 11/23/2019 2:55 AM (GMT 0)
Oh, my rates are going up too...
Posted 11/23/2019 5:26 AM (GMT 0)
Been dealing with this myself for the last couple weeks. of course I am talking about Medicare part d. There were lots of options and different plans covered different drugs. But it really irritated me that silverscript (which I think is blue shield?) Covered Apriso in 2019 at a fairly reasonable price but they are dropping it for 2020 and they said if I got the Dr to do all the prior approvals and they accepted it, the cost to me would be $1500 per MONTH!!!! That's crazy stuff. The only UC drug they had listed in the formulary was Asacol I think. Maybe canasa too. That's supposed to be options? Two drugs?

Some of the plans prices the generic mesalamine as even more than apriso. other plans have it as only about 25% less than brand names. So apparently it's not enough that we have to suffer through all the pain and indignities of this disease but we also have to go into the poor house trying to get better?
Posted 11/23/2019 1:33 PM (GMT 0)
I've been using generic mesalamine tablets in place of Asacol HD. Can't really say how good it is since Asacol was never enough by itseilf. The generic mesalamine enemas are the only ones I have ever used (never had brand name Rowasa) and those work ok.

I really hate these drug formularies. For people like us with chronic conditions it's so hard to find a drug that works to control our symptoms and then some bureaucrat at insurance decides they aren't getting enough of a deal from the pharmaceutical industry so they remove the drug from the formulary and dictate to us that their substitutes work just as well. The substitutes don't always work as well making us sicker. I really think that there ought to be a law that if your plan covers a medication it needs to always cover that medication. They can change their formulary for new patients but if you were on a drug before the change they shouldn't be allowed to force you to take something else. It's just wrong.

There are some here who think they should be able to do whatever they want because it's a business decision -- companies are responsible to their share holders -- not the patients. That is also just wrong. It may be legal, but it's morally wrong to tell sick people they can't have a drug that works unless they can afford it without insurance.
Posted 11/23/2019 1:36 PM (GMT 0)
Flowers -- you could get a coupon from GoodRx for Apriso, but it still looks like it will cost you snout $500/month.
It's open enrollment right now, can you shop for a drug plan or supplemental that will cover Apriso?
Posted 11/23/2019 4:16 PM (GMT 0)
I have BCBS Federal and have not received any such letter. Rates tend to go up every year, don't they? Or do you mean rates for prescriptions? I wasted $1,000 on Remicade (mostly bc I didnt realize infusions were so much more pricey at a hospital but also blood tests are so expensive and now I'm needing blood tests all the time on Imuran!) Just sent a $500 to the hospital for a drug that worked for 2 months. That was fun!

Do all those drugs you listed have generics available?
Posted 11/23/2019 5:03 PM (GMT 0)
I’m surprised they took Canasa out! It’s the most effective supp for Proctitis ( at least for me).
Posted 11/23/2019 6:38 PM (GMT 0)
The reason Canasa is removed is likely because there is an identical generic now. Also, there are easy to use patient assistance programs for both Apriso (manufacturer copay card is $10/mo) and Canasa, so that is helpful.
Posted 11/23/2019 6:58 PM (GMT 0)
BCBS policies vary wildly state to state, and business to business, so these changes do not broadly apply to everyone who has a BCBS policy.

I have BCBS of VT here.
Posted 11/23/2019 9:57 PM (GMT 0)
Medicare does not allow the use of any copay coupons or programs. I know goodrx is different but can't afford $500/ month. It was written into the rules that Medicare can't negotiate drug prices so the manufactures don't allow us to use their coupons. A lot of the drug companies do have no cost programs. I'm getting my migraine shots for free, have received canasa and uceris foam and apriso in the past This year I was excluded from the apriso program because it was covered by my plan. For 2020 I almost chose a plan that didn't cover apriso so I could get it for free again but didn't want to take that chance. I might still qualify once I know what the actual cost will be. Their criteria is that the drug has to cost more than 5% of my income.

CC I agree. I think what the drug companies are doing should be illegal.
Posted 11/23/2019 10:25 PM (GMT 0)

FlowersGal said...
Medicare does not allow the use of any copay coupons or programs. I know goodrx is different but can't afford $500/ month. It was written into the rules that Medicare can't negotiate drug prices so the manufactures don't allow us to use their coupons. A lot of the drug companies do have no cost programs. I'm getting my migraine shots for free, have received canasa and uceris foam and apriso in the past This year I was excluded from the apriso program because it was covered by my plan. For 2020 I almost chose a plan that didn't cover apriso so I could get it for free again but didn't want to take that chance. I might still qualify once I know what the actual cost will be. Their criteria is that the drug has to cost more than 5% of my income.

CC I agree. I think what the drug companies are doing should be illegal.

How do you pay for your Enyvio without drug co pay assitance if you don't mind me asking?

Medicare for all sounds good in theory, but I think my work insurance sounds better.
Posted 11/24/2019 5:21 AM (GMT 0)
You asked for opinions:
If you need the medication, and it’s not covered buy your insurance, consider buying it using GoodRx or online Canadian Pharmacies.
My insurance company doesn’t cover Dipentum, I buy it from over seas, even Imuran it’s cheaper outside the USA, starting next year I will start buying generic Canasa using Canadian Pharmacies.
All the cost will not go towards the deductible, but I will not sacrifice my health for the sake of “ Health Insurance”
Posted 11/25/2019 1:04 PM (GMT 0)

FlowersGal said...
Medicare does not allow the use of any copay coupons or programs. I know goodrx is different but can't afford $500/ month. It was written into the rules that Medicare can't negotiate drug prices so the manufactures don't allow us to use their coupons. A lot of the drug companies do have no cost programs. I'm getting my migraine shots for free, have received canasa and uceris foam and apriso in the past This year I was excluded from the apriso program because it was covered by my plan. For 2020 I almost chose a plan that didn't cover apriso so I could get it for free again but didn't want to take that chance. I might still qualify once I know what the actual cost will be. Their criteria is that the drug has to cost more than 5% of my income.

CC I agree. I think what the drug companies are doing should be illegal.

I keep going back to this but.....make it illegal and you won't have any medicine.....if I'm running a drug company and you dictate to me how much I can charge, and what I can do, why would I be in that business at all....? And I don't know the last time you were in a government run organization but I sure as **** don't want medicine coming out of a government run organization when I know how inefficient it was to get a drivers license....or the fact that 5 months later I'm still waiting on global entry...
Posted 11/25/2019 5:39 PM (GMT 0)
CC - entyvio is covered under the medical side of Medicare since it is an infusion and administered in a hospital setting. I have regular Medicare with a Plan F supplemental so I have no out of pocket cost thank god.

I did find a plan that covers my meds. It was just a day long slogfest looking up all my drugs and the plans. Medicare has a pretty good online tool now but there were at least 30 plans to go through, and costs and copays were all different.

I’m all for drug companies recouping their research costs but when they just get greedy that’s another thing altogether. Insulin for example has been around for over 50 years so why is the cost going up just lately? Why should my cost for Apriso go from $100/ month to $1500 in one year? I don’t want to see government involved either but what are we supposed to do if the companies won’t self regulate themselves.

Anyway I don’t want to get into a big debate. Just venting frustration with the whole process.
Posted 11/25/2019 6:41 PM (GMT 0)
I'm all for government intervention. If I was king/dictator for a day, I would sick the government on health insurance and pharmaceuticals and base the price on what other countries pay, and give us all universal and affordable healthcare coverage. It's all smoke, mirrors, and excuses (we need the crazy /humira/remicade/etc prices to research future drugs) which ignores the simple fact that most clinical studies are mostly government funded, already lol. Yeah there's inherent risk in a drug under development not making it to market, but that does not justify 10's of billions a year in profits from just humira. Nor does it justify patent abuse of mesalamines, taking over 20 years for a generic to come to market. It's just insane and likely will not change anytime soon.
Posted 11/26/2019 1:34 AM (GMT 0)
I was on Asacol HD up until my insurance company sent me a similar letter saying they wouldn't cover it (which is understandable as Asacol's manufacturer is engaged in some MAJORLY shady business practices - they successfully prevented Asacol from going generic, and they rebranded Asacol as "Delzicol" and somehow kept patent exclusivity on it 20+ years in. . . )

Anyway I switched to generic Lialda, under which my health has been a lot better. Later on I switched to buying it through "international pharmacy referral services" at one seventh of the price it's sold by Express scripts.
Posted 11/26/2019 3:54 AM (GMT 0)
This post makes me nervous. My insurance is switching from CIGNA to BCBS as of the new year. So far I’m only taking generic Canasa and supposedly our new policy is identical to the one we have with CIGNA but that remains to be seen.
Posted 12/12/2019 11:36 PM (GMT 0)
Thank you posting this. I just changed to a different BCBS plan for 2020 so your post spurred me to call and make sure I could still get Apriso. The answer was yes but my copay is now $95, was $45. I’m glad I found this out in advance!!
Posted 12/13/2019 2:54 AM (GMT 0)
Hey all, I have been traveling lately for work assignments and have just now read your responses. I do not wish for anyone to be nervous; just informed that there MAY be some changes. I see that Uceris Foam will NOT be covered at all and the alternative is ''mesalamine enema''. Canasa alternative shows ''mesalamine enema''. My monthy rate increased by about $40 for what? less coverage. I don't abuse my insurance or request crazy expensive drugs. Its not just the pharmaceuticals, my Dr./outpatient facility charges about $1500 cash for a colonoscopy (no insurance); It looks like Insurance pays them about $300 for the same thing. UGhh!
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