Insurance won't pay for medicine anymore, help!

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KaseyF
Regular Member


Date Joined May 2008
Total Posts : 65
   Posted 8/11/2008 7:37 AM (GMT -6)   
Hi everyone. I've been happily using sulfasalazine 500mg x4 a day since I was diagnosed in May. The pills work wonders for me. I've had no problems. Until I tried to refill my monthly prescription yesterday, and the pharmacy told me there's a note on my account that insurance will only cover 2 refills per year, and I'm now over my limit. The pharmacist was nice enough to give me a supply of pills to get me through today, but after that, I don't know what to do... I can't afford to pay the high-cost for these pills. I'm currently unemployed and having a really hard time finding work in my field. I've signed with temp agencies and they don't have any work either...it's basically a nightmare. Paying the high costs just isn't an option right now, but neither is stopping the pills.

I'm just at a loss with what to do. I'm going to call my insurance company, but I don't even know what to say to them to convince them to cover me.

I'd appreciate any advice on this subject. Thanks!
27 years old, Female, NYC
Diagnosed with severe UC on May 13, 2008 (though I'd apparently had it for years)
500 MG Sulfasalazine two pills x3 a day
Daily Multi-V, Folic Acid


dakotagirl
Veteran Member


Date Joined Apr 2006
Total Posts : 3402
   Posted 8/11/2008 8:48 AM (GMT -6)   
Very strange that they wouldn't cover sulfasalazine. It's one of the least expensive IBD meds - if not THE least expensive one.

Let us know what the insurance says. Also, if they're still not going to cover you, better call your GI right away and see if he can get you some samples.
Pan-colitis and GERD diagnosed May 2003
Osteopenia (hip and spine) diagnosed Feb 2006
Status:  Remission?!?!?
Asacol 12 per day,  Azathioprine 100mg, Aciphex, Forvia, and Pro-Bio
Remicade: 1st infusion 06/17/08:  Next (3rd) infusion 08/12/08
Last Prednisone dose:  7/15/08
 
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Lonie
Veteran Member


Date Joined Feb 2005
Total Posts : 6448
   Posted 8/11/2008 8:55 AM (GMT -6)   
Also call your doc and ask for some samples; some docs keep these on hand. Also, find out who the drug manufacturer is and call the 1-800 number and ask if you can get some help on payment for the meds.

Carol

Remicade - will have my 22nd infusion on June 12.
Vitamin B-12/Biotin, Probiotics
 
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Red_34
Elite Member


Date Joined Apr 2004
Total Posts : 23551
   Posted 8/11/2008 9:12 AM (GMT -6)   
That is crazy! You have a lifelong chronic illness that is managed long term with medication. Why in the world would an insurance company put a limit on only 2 refills?? I would call them up and explain the situation and if they still give you the run around, ask for an appeal. I agree that you should call your GI and see if they have samples. Sulfasalazine is the cheapest of all IBD meds like Dakota said. When I had no insurance, I was place on Sulfasalazine and at the time - 13 years ago - it was only about $15 compared to the $600 (at the time) of Asacol. I am pretty sure that it is still rather inexpensive but if someone has a limited income, it can seem like a lot.
 @--->--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**~Year-round allergies-Singulair, Allegra~Secondary Reynauds Syndrome-'04-Norvasc~Spinal Stenosis(?)~Sacroiliitis-epidural injections~bulging and herniated discs C5/C6 & C6/C7~2nd epidural injection 8/14, Neurontin and Skelaxin
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Beth75
Veteran Member


Date Joined Jul 2007
Total Posts : 2148
   Posted 8/11/2008 11:00 AM (GMT -6)   
how much is the sulfasalazine w/out insurance?

look up charities in your area, church and non-church ones. Tell your GI.

Can you work at Starbucks or UPS or a chain restaurant, most of these places have insurance and can help carry you until you find the job in your field and I think you only have to work 20-30 hours a week at these places to get insurance.
Beth, 32 ~ hoping to taper pred successfully, wish me luck!
Major Flare Sept/Oct 07
UC dx'd 03/00 (Proctosigmoiditis); Pancolitis since 09/07
Azathioprine 200mg 1xday nightly; Calcium and Vit D 500mg 3xday, Multi Vit, Folic Acid 400mg 2xday, Prilosec, Probiotics.
Minimal Change Disease (Kidney Disorder) dx'd 09/07 - partial remission since 03/08
Prednisone 15mg 1xday, Simvastatin 20mg 1xday, Diovan 160mg 2xday. Tekturna 300mg 1xday, Fosomax 70mg 1xweek. MCD may be from hypersensitivty to 5ASA drugs.  Do you have edema? If so, check your blood protien level!
 


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 8/11/2008 12:17 PM (GMT -6)   
Add Petco, home depot and Lowes to that list.

It might just be a mistake so make sure you call them ASAP. It wouldn't hurt to let them know how much more they would be paying if you switch meds.
26 Year old married female law student (last year!!). Diagnosed w/ CD 4 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant too but can handle anything cultured and do well w/ lactose pills and lactaid. For crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night. I also take a birth control pill to allow some fun in my life.


Old Hat
Veteran Member


Date Joined Feb 2007
Total Posts : 5191
   Posted 8/11/2008 12:20 PM (GMT -6)   
If you can't get quick help from insurance co. or doctor, contact the Community Service Society. They employ social workers to help the financially needy & can get cash grants to tide clients over in emergency situations. Needing money for medicine if insurance won't pay should certainly qualify a UCer for this type of assistance. I feel certain from what I've read about the CSS in NYC that they'd be helpful to you. / Old Hat (nearly 30 yrs with left-sided UC; currently on 3 Colazal daily for maintenance of remission)

ediekristen
Veteran Member


Date Joined Apr 2007
Total Posts : 1366
   Posted 8/11/2008 12:32 PM (GMT -6)   
2 refills? That's unreal, seriously. How can they even justify something like that?? I agree that you should call the insurance company and see what the deal is there.

Also, try www.rxassist.org ... you should qualify to be able to receive the medications for free or at least for a small cost.

Female, 23, Ulcerative colitis (pancolitis) diagnosed at age 15; GERD; gastritis; osteopenia in femur head & lumbar spine from long term prednisone use. 

Current Meds:
Lexapro 10mg
Trying out Lialda, 2 pills/day

 
 


KaseyF
Regular Member


Date Joined May 2008
Total Posts : 65
   Posted 8/11/2008 12:53 PM (GMT -6)   
Okay! So I called the insurance company and apparently they have a policy where they will only cover 2 refills for maintenance meds and after that, I have to order them through the insurance company itself. It would have been nice if they told me this. I found all my papers and there's nothing in my policy that states this. But whatever. So now I just need to call my doctor and have him send a prescription there and everything will be mailed to me from now on. Unfortunately, I'll have to pay for this month's pills because I didn't know this in time.

Yeah, I've thought about getting a job at one of these places like Starbucks. The problem is that I have joint pain and can't stand up for long periods of time. The sulfa isn't helping with the joint pain, and the GI tried to up my dose to 2pills x3 a day, but it was too much for me and I started getting stomach and headaches plus my BMs increased even though the joint pain DID subside. I decided the joint pain is a better trade off to having delightful BMs (only once in the morning, completely solid) and no other side effects. Usually i'm sitting at a desk, so the joint pain doesn't really affect me too much.

I'm trying to expand my field right now. (I do both freelance graphics and writing). I'm going to look into photoshop and web design projects instead of video animation projects. The writing field is not so good at the momentg, so I may need to put this on hold for now even if it's the kind of work I prefer. (I'm on insurance through my live-in boyfriend as a domestic partner. We recently got "audited" to see if they would still cover me, I thought at first this was somehow related, but we did get approved for my coverage, so this is just wacky insurance policy.)
27 years old, Female, NYC
Diagnosed with severe UC on May 13, 2008 (though I'd apparently had it for years)
500 MG Sulfasalazine two pills x3 a day
Daily Multi-V, Folic Acid


Beth75
Veteran Member


Date Joined Jul 2007
Total Posts : 2148
   Posted 8/11/2008 1:03 PM (GMT -6)   
glad that it worked out, definitely stay on your meds and try not to let anything (other than health issues that you cant control) get in your way of staying on it!

you can also do at home party type jobs to help supplement your income to pay for meds if needed, like Lia Sophia or others. I did Lia Sophia for a bit, and besides hosting my own party at first to get the free jewelry (I bought food for the party), I got a free kit and everything.........then I got dx'd w/Kidney Disease and went into the flare from hell........but if you are not flaring might be a good to look into. I am thinking of starting up again, you only need 1 party a year to stay active.
Beth, 32 ~ hoping to taper pred successfully, wish me luck!
Major Flare Sept/Oct 07
UC dx'd 03/00 (Proctosigmoiditis); Pancolitis since 09/07
Azathioprine 200mg 1xday nightly; Calcium and Vit D 500mg 3xday, Multi Vit, Folic Acid 400mg 2xday, Prilosec, Probiotics.
Minimal Change Disease (Kidney Disorder) dx'd 09/07 - partial remission since 03/08
Prednisone 15mg 1xday, Simvastatin 20mg 1xday, Diovan 160mg 2xday. Tekturna 300mg 1xday, Fosomax 70mg 1xweek. MCD may be from hypersensitivty to 5ASA drugs.  Do you have edema? If so, check your blood protien level!
 


sodbuster19
Regular Member


Date Joined Sep 2007
Total Posts : 343
   Posted 8/11/2008 3:10 PM (GMT -6)   
I live in NY also. Do you mind telling what Insurance co you have?

<FONT color=#0000ff>Bad flares Guniess & hot wings

Generic Colazal, 2 2xday
Acidophilus Probotic 3 times/day


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 8/12/2008 8:10 AM (GMT -6)   
Kasey! The same exact thing happened to me. I totally forgot and never even thought that it could be your problem. My copays had been $30/month and one day I picked up my pentasa and it was $70. It was because they failed to tell me my maintenence meds had to go through mail order or else I had to pay a much higher copay. I got stuck paying it that month but it was worth it to stay on it. It turns out that after much complaining I actually like mail order. Its way cheaper, and I have less trips to the pharmacy. I always have almost a 3 month supply of meds on hand too. The only downside is if your doc switches your meds then you have all that left over. Glad you figured it out!
26 Year old married female law student (last year!!). Diagnosed w/ CD 4 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant too but can handle anything cultured and do well w/ lactose pills and lactaid. For crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night. I also take a birth control pill to allow some fun in my life.


IndianaUC
Regular Member


Date Joined Feb 2007
Total Posts : 212
   Posted 8/12/2008 6:13 PM (GMT -6)   
I live in Indiana and we have the $4 program at many of the pharmacies. I had to call around and do some checking on the internet, but finally found a place that had my sulfasalazine on their program. I pay $15 for a 90 day supply. If this is available in your area just be sure that the pharmacy orders the pills from Greenstone Labs. The ones from Watson Labs are not the same and in fact made me flare worse.
- DXed with "left sided" UC in 1998. DXed with "proctitis" Oct. 2007
- Sulfasalazine 4 500mg tabs twice daily
- 500mg Vitamin C, 1 Multivitamin, L-Glutamine
- Max Acidophillis EC Capsules 350Mg(7 types of bacteria with over 42 billion viable cells) with 50 Mg colostrum & 50 Mg FOS(fructo-oligosaccharides)
- Experimenting with this or that on occasion. Always open to new ideas.
- Colonoscopies - 2 (Due for my next one ASAP)

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