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Getting mesalamine covered as a "preventative drug"

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Ulcerative Colitis
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Posted 10/20/2017 6:59 PM (GMT 0)
I was just reading in my company's health insurance booklet that for the HSA plans they are trying to push us into, "generic preventative drugs in certain categories are covered at 100% (no deductible applies.) "

It does not appear that mesalamine is listed as a "preventative drug" but the wording sound like the list is not all-inclusive and may include other stuff if you request it.

Has anyone had any luck getting mesalamine drugs considered a "preventative drug" and thus paid by insurance with no deductible/copay? After all, it is hopefully preventing the next flareup . . .
Posted 10/20/2017 7:33 PM (GMT 0)
I'd call and ask your insurance company whether any of the available UC medications are included, and if so which ones. We're all for saving on copays, if there's a way to.

Things like generic-Lialda (aka Mesalamine Delayed-Release), generic asacol-hd, generic balsalazide disodium, generic Olsalazine, generic-sulfasalazine, generic Rowasa Enema, and others might be covered.

It will likely not include brandnamed Lialda, Delzicol, Apriso, and others.

Good luck and let us know what you findout. Honestly though, insurance plans vary so much policy-to-policy and state-to-state that everyone has different rules to follow. It's so different everywhere...
Posted 10/20/2017 7:37 PM (GMT 0)
I don't think it is preventative, unless you didn't have UC, but you had a very high likelihood of developing it and you took it prior to diagnosis. If you're diagnosed, it would be a treatment, not a preventative. I personally would try to fight it, but I can't see it ever being seen as preventative in someone who's already got a diagnosis. I find these HSA plans to kind of suck. More beneficial to the corporations than the individuals. They are great for healthy people, but for people with chronic illnesses, the out of pocket costs can end up being high.
Posted 10/20/2017 8:14 PM (GMT 0)
I believe NSSG is right. I did some quick searching and it look highly unlikely UC meds are included. It's only medications for common ailments
Posted 10/20/2017 8:38 PM (GMT 0)
I wonder if statins that "treat" high blood pressure, but "prevent" associated strokes are covered.

I see an argument where UC meds treat flares, but at maintence doses there is no inflammation to treat, and they are taken as "preventative" of a flare, or even of surgery.
Posted 10/20/2017 8:51 PM (GMT 0)

DBwithUC said...
I wonder if statins that "treat" high blood pressure, but "prevent" associated strokes are covered.

I see an argument where UC meds treat flares, but at maintence doses there is no inflammation to treat, and they are taken as "preventative" of a flare, or even of surgery.

I was thinking about that too. You're preventing the stroke I guess.

With UC, what are you really preventing? You've already got UC. I guess you can prevent inflammation or further inflammation, but I took the drugs and still had inflammation, so it technically prevented nothing in my case.

It definitely makes sense for them to cover it, but I could see insurance companies trying to get out of it.

I think you should put up a fight and see. There's generic now too.
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