Reasonably priced therapy

I am taking mesalamine. I have been getting Humira through Patient Assistance Program but it has stopped working and I may be a little over income for next year. My doctor suggested Stelara after colonoscopy but it looks like in northeastern FL on Medicare Advantage this would cost a minimum of 48k a year! I’ve been told Janssen no longer offers patient assistance if on Medicare.
Can anyone suggest a more reasonable approach I can suggest to my doctor at July 11 appt?
How much is imuran with health insurance? What about azasan? Are either of these reasonable with mesalamine? I could try budesonide short term but do not like prednisone at all.
What about methotrexate?
My best idea is since I’m eligible for Humira through 2023, to increase dosage to weekly with new RX and get lab work in December. Right now the Humira level is low and antibodies are high. My dr. doesn’t think increasing dosage will help due to antibodies but some doctors have tried this approach.
I appreciate any ideas for continuing treatment short of very expensive biologics. Thanks so much.

Generally the generic sister meds of azathiopurine (AZA) and 6-meracaptopurine (6MP) are pretty inexpensive and most used for UC. Methotrexate is a Crohn's med, it can be used for UC but not commonly.

I cannot say what exactly they'd cost you with Medicare advantage plan. I'd call your health insurance and ask, or visit your pharmacy and ask.

6MP and aza are both weight based drugs. You can estimate your dosage to figure cost.

6MP is dosed 1.0 to 1.5 milligrams to each kilogram of patient body weight (usually to the pill size). A 155 pound/70 kilogram patient would take between 70 and 105 milligrams of 6mp a day (likely 75 or 100 based on available pill sizes). That's about $60 a month (lower dose given) without insurance using goodrx cash pricing

Aza is dosed 2.0 to 2.5 milligrams to each kilogram of patient body weight (usually to the pill size). A 155 pound/70 kilogram patient would take between 140 and 175 milligrams of aza a day (likely 150 or 175 based on available pill sizes). That's about $30 a month (lower dose given) without insurance using goodrx cash pricing.

Budesonide is generally pretty expensive, I believe a 8 week course of Uceris is around $2,000, again cash not insurance pricing. Entocort EC might be a little cheaper. Generally want to avoid long-term corticosteroid usage, anyways. Yeah budesonide is safer than Pred but it's not immune to the same irreversible corticosteroid side effects like type ii diabetes, osteoporosis, etc.

Other than that, there's compassionate use programs that offer the drug for free to participants meeting their financial requirements by biologics makers. Jannsen (remicade/stelara), abbvie (humira), Pfizer (renflixis) a bio-similar of remicade, takeda (entyvio). These programs are different than the patient copay assistance programs, although not sure if other manufacturers might also support Medicare

Good luck with your upcoming medical consults, including the possibility of drug trial participation. I suffered through 20 years of repeat UC flares before my gastroenterologist enrolled me in NIH phase II trials for Colazal. We had to do 2 successive 10-week periods of drug intake, which proved hard because the existing med formula made many of us dizzy! I also got puffy, itching eyes from the med during each trial period. Thankfully, the manufacturer then revised the drug formula to remove the chemical irritants-- because Colazal then became my miracle break-through to longterm remission. If your inflammation has become left-sided, you might ask your gastroenterologist whether brandname Colazal could help you. It's now hard to get due to chain pharmas stocking the cheaper Balsalazide generics, but Express scripts can dispense it for patients on original Medicare who have independent Part D drug coverage. (Rather than Medicare Advantage Plans which have their own drug formularies.) / Old Hat (40+ years with left-sided UC; in remission taking Colazal)