Does your insurance (USA) cover cortifoam?

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julee70
Regular Member


Date Joined Oct 2007
Total Posts : 486
   Posted 2/13/2008 1:42 AM (GMT -6)   
I just had a strange experience at the pharmacy with my new insurance. I'm going to call them about it but I want to know other people's experience first. My dr. prescribed Cortifoam, 1 time per day at night. The pharmacy handed me 1 box of cortifoam and wanted to charge me my full co-pay. I know that the boxes are only about 15 applications, so that seemed off to me. When I looked, the box said it was a 20 day supply. They said my insurance only covers 20 days of Cortifoam. Of course, I said I'd come back with a script for twice the dose so that I could get enough for the month! Sometimes I use it twice a day, so 1 box is definitely not enough for a month.

Anyone else find restrictions on Cortifoam with their insurance? Do you find that you need 2 boxes (1 canister each) to make it through 30 doses?

Thanks! I'm looking forward to a fun call with my insurance company talking about rectal foam. :-)
-------
UC for the last ten years
Current Meds: 6MP
Past Meds: You name it; I've tried it.


Red_34
Elite Member


Date Joined Apr 2004
Total Posts : 23551
   Posted 2/13/2008 6:59 AM (GMT -6)   
I have Blue Care Network and they get a little strange with their prescription coverage but I have never been denied for any of my Uc meds. Usually my insurance will try to get me to use OTC meds first (such as for Clariten, Prilosec etc) but with UC that is not an option because there is no OTC variation. It does seem a bit strange for an insurance company to only pay for 20 days......is that the typical duration for this? I know with my insurance if I need a med that is not covered, my doc can call and give them a medical authorization.
 @--->--SHERRY--<---@
Moderator for Allergies/Asthma and Co-moderator for UC
~Left sided Uc -'92 - Colazal (9 daily), 6mp (50-100mgs), Prilosec, Biotin, Forvia, Pro-Bio**Unable to tolerate Asacol, Rowasa or Canasa** ~Allergies - Singulair
~Secondary Reynauds Syndrome -'04 - Norvasc~Fibromyalgia -'06~No meds
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braillegirl
Regular Member


Date Joined Jan 2008
Total Posts : 66
   Posted 2/13/2008 7:41 AM (GMT -6)   

I just had this happen to me. I have not been on cortifoam for quite awhile so I could not remember how long a canister lasted...But I questioned it. I am to take it for 3 weeks...It had better last that long. Also, I don't think the thing is working right. Has anyone had one that would not fill the thing up right? I have to push the handles a lot to get just a little in the tube. I am thinking about taking it back to pharmacy and questioning them about it. Anythoughts? I also am going to question the dr. about his perscription. I am to take it for 3 weeks with one refill. Why didn't he make it for a month? That way I hopefully would have gotten two canisters. Also I know every insurance is different but was just wondering how much you paid for the canister. I had to pay $53.00! I have an inquiry in to my insurance company.

 


julee70
Regular Member


Date Joined Oct 2007
Total Posts : 486
   Posted 2/13/2008 7:41 AM (GMT -6)   
Thanks, Sherry. I noticed the "medical authorization" clause in my insurance summary so I know it's an option. I think it's such a pain to get to the pharmacy in the evening, wait on line and find out that I have to wait until the next morning to reach my doctor to fix the situation and then go back to the pharmacy. I guess it will be worth it but I hate jumping through hoops.

I hope someone else can weigh in about this 20 day supply thing. I've never heard of that and I swear that I've never gotten 20 days out of one canister of Cortifoam! (And I thought I was good at making them last forever :)
-------
UC for the last ten years
Current Meds: 6MP since 2006
Past Meds: You name it; I've tried it.


Old Hat
Veteran Member


Date Joined Feb 2007
Total Posts : 5187
   Posted 2/13/2008 12:11 PM (GMT -6)   
Hey, Julee-- I think part of the issue is the canisters. In my experience one can get ca. 10 days of single dose Cortifoam from a canister because the propellant takes up some of the space in it. The insurers (also some MDs) fail to understand this! As a result, the chain pharmacies generally do not want to give more than one canister at a time, though they seem to accept the concept of refills-- also one at a time. Many moons back a kindly pharmacist told me that it was because of the reimbursement schedule from the insurer-- so I tend to believe that's the other part of this issue. Recently my IBD-subspecialist gastro wrote me a prescription for Proctofoam HC-- 6 canisters (figuring I could keep a supply on hand in case hemmies crop up), but the chain pharmacy would only give me one canister + one refill.
Had I realized during office visit that Rx requested 6 canisters, I would have mentioned the insurance-imposed limitations issue to the gastro right then & there!!!!! / Old Hat (nearly 30 yrs with left-sided UC ... [etc.])

ks1905
Veteran Member


Date Joined Sep 2005
Total Posts : 5136
   Posted 2/13/2008 12:26 PM (GMT -6)   
You have to call your insurance company..... I got the run-around from them for a couple of different meds. Colocort is actually a 28-day supply and they told me that they would manually adjust for the couple of days to reflect the difference so I could refill it early.

I take Cyclosporine and it is a non-formulary so I have a $50 co-pay which I don't have a problem with but Blue Cross turns it into a $100 co-pay for me because I need 100 mg pills and 25 mg pills. So they force me to pay $50 x's 2. I say that it is one script and they tell me that it is two scripts (100 mgs and 25 mgs).... the GI only gave me one piece of paper for script. I lost the argument. So I just refill my Colocort script out of spite which costs them $600 and only costs me $10.... I don't even use colocort anymore, I just like to make Blue Cross to pay for it.

--Keith
DX'd with Pan-Colitis June 2005
Current Status: Flaring since May
 
Current Meds:  50 mgs 6-mp, Colocort, Oral Cyclosporine (500 mgs)
Supplements:  None 
 


Another UC wife
Veteran Member


Date Joined Jun 2007
Total Posts : 2111
   Posted 2/13/2008 7:05 PM (GMT -6)   
our blue cross PPO as a retiree has a decent prescription plan

the first time the script was written however for a 90 day supply it did not specify 6 boxes (canisters) and it was filled with 4 boxes. We find that we can get approx 15 applications per canister and 6 of them gets him through 90 days. So the next time the Dr wrote the prescription he indicated 90 day supply 6 boxes.

Unlike the directions say - I find that I need to push up and down multiple times to fill the plastic reservoir - it does expand so be sure to use one or two less pushes to let it expand a little.

61 yr old male~Colitis 1st diagnosed Jan '05-cleared up within a few wks. Flared again in May '06 (now UC) & hospitalized 5/07-currently heading towards a remission. Osteopena of spine from prednisone DX 8/07  Oct 07 feeling quite normal most days.  150mg Imuran  Zero mg prednisone   12 Asacol, Lidocaine Hydrochloride Jelly 2%,multi vitamin, iron 1X day, DanActive, chewable calcium, fiber capsule 1x day, Prilosec 20mg, enalapril 10mg, glipizide 5 mg, zocor 40 mg, baby aspirin, (Fentanyl pain patch 50mg 72 hrs  Morphine Sulf 15 mg twice daily)Cortifoam enema PM, Canasa suppositiry AM, folic acid 1mg, Fosamax 1x month


julee70
Regular Member


Date Joined Oct 2007
Total Posts : 486
   Posted 2/13/2008 9:16 PM (GMT -6)   
Thanks, everyone for your input. This is helpful. I think asking for a different prescription (2 boxes) and having the doctor call the insurance company will probably be the best. A lot of annoying steps for something that should be easy. I am going to take this up with the insurance company because it is really impossible to get 20 days out of one measly canister.

Braille-- I've had tops that don't work right too. Sometimes they just need to be cleaned because the slightest amount of buildup causes all the foam to build up underneath.

Keith, I can really understand why you fill the colocort script! These carriers don't realize that we are not working with them to control costs because the rules they establish don't make sense.
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UC for the last ten years
Current Meds: 6MP since 2006
Past Meds: You name it; I've tried it.


Sara14
Veteran Member


Date Joined Mar 2007
Total Posts : 4509
   Posted 2/13/2008 10:24 PM (GMT -6)   
Hey julee. I can't relate to the Cortifoam, b/c I have never used it, but my Rowasa prescription is only for a 2-week supply, which is really annoying. I don't know why my GI doesn't write it out for a month. Would it cost me the same for a month's supply if he wrote it out like that? Good luck with figuring out your Cortifoam situation. It sucks all the work we sometimes have to do just to get our meds.


24 years old
Diagnosed with UC March 2007; yet to go into remission
Asacol 4 tablets 3x/day
Rowasa (generic) - daily
Nature's Way Primadophilus Reuteri 1/day; Chewable multivitamin; Metamucil; Viactiv (Calcium and Vit. D)


Old Hat
Veteran Member


Date Joined Feb 2007
Total Posts : 5187
   Posted 2/13/2008 10:43 PM (GMT -6)   
Julee, I'm really glad you posted this! Luckily I haven't needed Cortifoam for a long while, but reading this thread reminded me that how the pharmacy dispenses it can indeed cause problems, whether financial or logistic. As Braille wrote, sometimes the canister caps malfunction. If they let too much air escape initially, there's no way a canister is going to last through 15 applications of Cortifoam. Obviously, Another UC Wife has mastered the art of handling the aerosol! I don't think I ever got more than 12 doses out of one canister, ever. Maybe pb4 will weigh in on this dosage point, though she's in Canada & doesn't share our insurance hurdles, she's a veteran user of The Foam. / Old Hat

julee70
Regular Member


Date Joined Oct 2007
Total Posts : 486
   Posted 2/14/2008 8:38 PM (GMT -6)   
I forgot the mention the REALLY stupid part of all this. I had a lot of extra old canisters and tops and applicators and I threw them away like an idiot about 3 months ago when I felt invincible. Even though the med had expired, I should have kept those tops!
-------
UC for the last ten years
Current Meds: 6MP since 2006
Past Meds: You name it; I've tried it.


braillegirl
Regular Member


Date Joined Jan 2008
Total Posts : 66
   Posted 2/15/2008 7:11 AM (GMT -6)   
I also had an old top with the medicine expired. I tried to switch tops. The old one worked fine on old canister but not new one. Darn. I see my Dr. on Thursday and I am asking him for a 3 months supply and to specify 6 boxes. I don't care if it expires because I never use it. It will be cheaper for the 3 months than for 1 from the pharmacy!
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