Lialda - non formulary drugs - what does your insurance say it is

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okiemom
Regular Member


Date Joined Sep 2007
Total Posts : 104
   Posted 10/11/2007 4:28 PM (GMT -7)   
Okay, so what foes your insurance say it is???
 
 
 
Diagonsed with UC in about 99 - 
Started new GI 9-25-07
Lialda 2.4 in AM(started 9-26-07) canasa 1000mg  2xs per day(started 9-26-07)
Probiotics, calcium with Vitamin D, slow release Iron, Psyllium Husk Fiber. 


Red_34
Forum Moderator


Date Joined Apr 2004
Total Posts : 23549
   Posted 10/11/2007 5:19 PM (GMT -7)   
If I wanted to go on Lialda, I couldn't because my insurance won't cover it. Not sure why though.
 @--->--SHERRY--<---@
Left sided Uc -'92 - Colazal, Canasa, 6mp, Prilosec, Biotin, Forvia
Secondary Reynauds Syndrome - '04 - Norvasc
Fibromyalgia - '06 
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UC Dude
Regular Member


Date Joined Aug 2005
Total Posts : 438
   Posted 10/11/2007 7:16 PM (GMT -7)   
Asacol offers the same outcome and most likely less expensive.  That is why it would be preferred.

 


Harpo
Regular Member


Date Joined Jul 2007
Total Posts : 262
   Posted 10/12/2007 5:58 AM (GMT -7)   
My insurance says its a 50 dollar co-pay...

Post Edited By Moderator (dakotagirl) : 10/12/2007 12:44:04 PM (GMT-6)


dakotagirl
Veteran Member


Date Joined Apr 2006
Total Posts : 3402
   Posted 10/12/2007 11:41 AM (GMT -7)   
Harpo - I just removed a word that I didn't think was appropriate for a family friendly site. I do agree however that a $50 copay is outrageous!
Pan-colitis and GERD diagnosed May 2003
 
Asacol 12 per day,  Azathioprine 75mg, Rowasa and Canasa as needed
Aciphex, Effexor XR, BCP, Rhinocort nasal spray
Culturelle, Biotin, Folic Acid, Forvia, Calcium, and B12
 
Osteopenia (hip and spine) from prednisone use.  Started Azathioprine because I was steroid dependent.
 
Co-Mod for the UC forum
Keep HealingWell running smoothly:  www.healingwell.com/donate


UC Dude
Regular Member


Date Joined Aug 2005
Total Posts : 438
   Posted 10/13/2007 4:15 AM (GMT -7)   
Insurance formularies go out for bid. There are rebates etc behind the scenes from the drug co's to the insurance carriers etc based on what I have read.


Lialda is also new so they may not have had a chance to go head to head with Asacol in the process. I am sure they will going forward.
 


kb5
Veteran Member


Date Joined Jan 2007
Total Posts : 1015
   Posted 10/13/2007 6:52 AM (GMT -7)   
My GI and i talked about remicade but my insurance said it was non-formulary and they wouldn't pay. But humira for some reason was covered. None of this makes sense to me. What I liked though was my GI went on a ten minute rant about insurnace companies and said that if the imuran didn't work he would figure it out for me.

I hate insurance at the same time i can't live without it.
Kelly, 29

Left sided UC diagnosed 1/98 age 19, Pan colitis diagnosed 1/07
Currently on 4x3 Asacol, Rowasa every other night, 15 mg pred. until immuran kicks in...
75mg Imuran starting 8/23/07---bumped to 100mg 10/8/07
Prontonix once daily for acid reflux, zofran twice daily for nausea


okiemom
Regular Member


Date Joined Sep 2007
Total Posts : 104
   Posted 10/13/2007 8:33 AM (GMT -7)   
I called and they said the drug was new - so I asked them to review it -
I then also emailed them asking them to review it -

my part was $70.00 - they paid $230 something -
Diagonsed with UC in about 99 - 
Started new GI 9-25-07
Lialda 2.4 in AM(started 9-26-07) canasa 1000mg  2xs per day(started 9-26-07)
Probiotics, calcium with Vitamin D, slow release Iron, Psyllium Husk Fiber. 


UC Dude
Regular Member


Date Joined Aug 2005
Total Posts : 438
   Posted 10/13/2007 12:42 PM (GMT -7)   
kb5 said...
My GI and i talked about remicade but my insurance said it was non-formulary and they wouldn't pay. But humira for some reason was covered. None of this makes sense to me.
kickbacks, shenanigans and cost containment
 


jujub
Forum Moderator


Date Joined Mar 2003
Total Posts : 10405
   Posted 10/14/2007 9:25 AM (GMT -7)   

Hint: any time your insurance denies something, question them. Ask to appeal the decision. Keep calling, they have hidden offices all over the country in many cases. I once spent a whole day talking to United Healthcare representatives - in Dallas, St. Louis, New York and finally California. Ask sincerely, whine, rant, cry, whatever. I made enough of a stir that each person kept kicking me up one level just to get rid of me, and I finally got to someone with the authority to override the decision and fix my problem. I work for the county, and they're "self-insured," so the insurance company just approves or disapproves the spending of my employer's money. My next step was going to be to go to the weekly county commissioner's meeting and speak to them publicly, in front of the TV cameras. I figured they wouldn't be happy to be portrayed as employers who deny their staff needed health care.

Your doctor will advocate for you. He will send a letter or two. He will not take a whole day to make these people uncomfortable, and he doesn't have direct access to decision-makers either. The sad truth is that your treatment was most likely denied by some high-school graduate with a computer program in front of him or her and no medical knowledge. The rules are made to keep their payouts low, so you have to advocate for yourself strongly. And be creative.

 


Judy
 
Left-sided UC diagnosed 2001.  Taking Colazal and Imuran, Remicade infusions and moving into remission. Finally off steroids after four years! 
 
Now in remission for almost two years. Remicade has been my wonder drug.
 
"If you spend your time second-guessing your past decisions, you'll never have time to enjoy today."


ledaebel
Regular Member


Date Joined Jul 2006
Total Posts : 339
   Posted 10/15/2007 7:53 AM (GMT -7)   

I was on a Lialda study for 7 weeks, with free Lialda,  but flunked out since I had not healed enough for their requirements.  I prayed my insurance would cover it so I made the call and believe it or not they covered it since they would consider Asacol a drug failure.  Apparently, they will cover it if you tried a drug on their formulary ( a list of drugs they prefer you use) first.

I feel so much better on the Lialda.  Mainly, the fatigue has disappeared and life is worth living again.  You forget what is normal after being sick for so long.  I used to feel as if labor pains had started again now its pretty normal, just the urgency.

I truly hope you can get yur insurance to pay.  Enlist your physicians help, mine just fax'd a form to the insurance the same day.  Its a nice drug for some of us.  Be persistant!  Also, I almost forgot, the makers of Lialda gave me a card limiting the $$$$ I'd have to pay out each month on the drug.  Not sure if this is only for the study participants, but it was a wonderfu  gesture.

 


  • LINDA
         
Prescriptions: Lialda (on a study) asacol, hycosamine, protonix, synthroid, zyrtec, avalide, nasocort, Miacalcin spray and Trazadone for sleep.
OTCs:  Usana multivitamins and multiminerals, Usana Procosa, Usana Mega Antioxidants, Omega 3, Vit. E,  Healthy trinity probiotics, Calcium Citrate


ledaebel
Regular Member


Date Joined Jul 2006
Total Posts : 339
   Posted 10/15/2007 7:54 AM (GMT -7)   
I forgot, I pay $80. for a three month supply through Caremark and my insurance.  Not bad.

  • LINDA
         
Prescriptions: Lialda (on a study) asacol, hycosamine, protonix, synthroid, zyrtec, avalide, nasocort, Miacalcin spray and Trazadone for sleep.
OTCs:  Usana multivitamins and multiminerals, Usana Procosa, Usana Mega Antioxidants, Omega 3, Vit. E,  Healthy trinity probiotics, Calcium Citrate


Beth75
Veteran Member


Date Joined Jul 2007
Total Posts : 2148
   Posted 10/15/2007 1:39 PM (GMT -7)   
my insurance paid for Lialda, I think it was a higher co-pay, but I did the three month thing. now I just have the bottle sitting there..........knowing I can't take it = `(

don't know why I haven't thrown it out yet..........
Beth, 32
UC Diagnosed March 2000
Hydrocortisone enemas 1xday
Lialda 2.4mg 1xday since 8/24/07 ;prev. Asacol 4800mg day,Calcium and Vit D 500mg 3xday.
Minimal Change Disease (Kidney Disorder) Diagnosed Sept 2007
Prednisone 60mg 1xday, Simvastatin 20mg 1xday, Diovan 80mg 1xday. Fosomax 70mg 1xweek. MCD may be from hypersensitivty to 5ASA drugs.


dakotagirl
Veteran Member


Date Joined Apr 2006
Total Posts : 3402
   Posted 10/16/2007 11:25 AM (GMT -7)   
Linda - you noticed less fatigue on Lialda? Very interesting! Might be something to look into :) Thanks.
Pan-colitis and GERD diagnosed May 2003
 
Asacol 12 per day,  Azathioprine 75mg, Rowasa and Canasa as needed
Aciphex, Effexor XR, BCP, Rhinocort nasal spray
Culturelle, Biotin, Folic Acid, Forvia, Calcium, and B12
 
Osteopenia (hip and spine) from prednisone use.  Started Azathioprine because I was steroid dependent.
 
Co-Mod for the UC forum
Keep HealingWell running smoothly:  www.healingwell.com/donate


Metallichic
Regular Member


Date Joined Oct 2007
Total Posts : 76
   Posted 10/17/2007 12:19 PM (GMT -7)   
I also have a $50 copay for Lialda, but it works so much better than Asacol, and 2 pills once a day is easier than 4 pills 4 times a day!

I do have a card that I got from my GI from the company that makes Lialda, it works like a seconday insurance, and you pay no more than $25 for the pills. I guess it's their way of trying to make sure that even though their drug is not on the formulary yet, that we continue to take it and not switch back to Asacol. It's only good for 3 refills, but you can get a new card from the doctor after 3 times. :)
Shannon
Asthma (diagnosed at 12)
Fibromyalgia (diagnosed 9/01)
Crohn's Disease/Colitis (diagnosed 12/02)
Diverticulitis (diagnosed 6/07)
Chronic pelvic pain/endometriosis, leading to hysterectomy (9/07)
Torn rotator cuff/labrum (repair 11/20/07)
Bladder sling (8/06), cholystectomy (2/06), tubal ligation (2/06), failed ablation (3/07)
Taking Lialda, Prednisone, Entocort, Remicade, Bentyl, NuLev, HCTZ, Lisinopril, Cymbalta, Effexor, Xifaxan, Flagyl, Lomotil, Frova, Questran powder/Carafate suspension, and pain meds.


dakotagirl
Veteran Member


Date Joined Apr 2006
Total Posts : 3402
   Posted 10/17/2007 6:27 PM (GMT -7)   
I just checked with my insurance. Lialda is a "preferred" drug - the same as Asacol. I have a maxium co-pay per prescription, so it probably wouldn't be any more than the Asacol - with this plan.

So, one Lialda pill is equivalent to three Asacol pills? I'd still be taking four per day - probably still split into two doses...
Pan-colitis and GERD diagnosed May 2003
 
Asacol 12 per day,  Azathioprine 75mg, Rowasa and Canasa as needed
Aciphex, Effexor XR, BCP, Rhinocort nasal spray
Forvia and a Probiotic
 
Osteopenia (hip and spine) from prednisone use.  Started Azathioprine because I was steroid dependent.
 
Co-Mod for the UC forum
Keep HealingWell running smoothly:  www.healingwell.com/donate

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