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Crohn's Disease Forum » Treatment » 5-ASA/Mesalamine » Has anyone had issues with their insurance not covering Pentasa?


02-19-2014, 02:04 PM   #1
texasagg02
 
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Join Date: Sep 2013
Location: North Carolina
Has anyone had issues with their insurance not covering Pentasa?

So I am on Pentasa (since last April when I was diagnosed with Crohns) as well as Entocort. I got a letter from my insurance carrier that they will no longer cover pentasa. Talked to my GI dr and he said the options my insurance is giving will not work for me since they are for the large bowel and only Pentasa covers the small bowel. They even called my insurance company and were told no, they will not cover it. (United Healthcare).

Just wondering if this is a common problem? Should I switch to another company like Blue Cross?

Only other option is to switch to a 6-MP. Dr is going to give me a month of samples that way I can stay on that while they try and wean me off the Entocort.

Thanks in advance for any info!!!!!
02-19-2014, 10:38 PM   #2
Essieluv
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There is a patience assistance program for Pentasa. You might want to check that out? http://www.shire.com/shireplc/en/patient-support
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Meds that failed me: Remicade, Humira, Cimzia, Entocort.

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02-20-2014, 08:06 AM   #3
texasagg02
 
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Thanks for the info, my husband makes too much money to be considered in a financial need. Even though he makes good money we can not budget 1,000 a month for the Pentasa. For now looks like my GI is going to give me samples and then I will switch to a 6-mp or we can buy myself a policy with Blue Cross for 350 a month and they cover it (I would just have to pay 70 a month for it, better then the 100 I was paying for it a month with United).

Such a pain and am irritated with my insurance thinking they can make decisions like this. The other meds in the same "class" only help the large bowel, Pentasa is the only one the helps the small bowel which my crohn's is only in the small bowel. The dr even called the insurance company to explain this.
02-20-2014, 08:18 AM   #4
myboy12
 
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Join Date: Jan 2014
Location: Chicago, Illinois

My Support Groups:
We have Blue Cross Blue Shield and we purchase my sons Pentasa through Express Scripts (also part of our plan) costing us only $70 for a 3 month supply versus $75 per month through CVS. I would of never known unless I called our provider asking about prescription coverage, worth a shot inquiring about Express Scripts.
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Son diagnosed at age 12, December 2014

Current meds: Remicade every 8 weeks (May 2014)
Past meds: Prednisone, 6MP and 3000 mg Pentasa
02-20-2014, 08:37 AM   #5
texasagg02
 
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70 for 3 months is awesome! If we switch insurance carriers I will for sure look into that! Thanks!!!!!!!
03-13-2014, 08:22 PM   #6
wingfam94
 
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Join Date: Mar 2014
Location: Lansing, Michigan
This is almost my same story! And the same insurance company. We don'tqualify for assistance with rthe manufacture either, since they do not take into account monthly expenses. I'm not doing well on what the GI doc replaced the Pentasa with. There is no replacement for Pentasa. I wish I had an answer for you but I'm just beginning this journey to find new medication that will work.
03-14-2014, 07:12 AM   #7
texasagg02
 
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Join Date: Sep 2013
Location: North Carolina
I am switching to a 6-mp, we appealed and they still say no. My dr even called and talked to them and said the options they gave me to replace to pentasa will not work for me since the other meds in the category only cover the large bowel and my crohns is only in the small bowel. I might has well be on nothing! I started the 6-mp yesterday but am still on pentasa while I make the change. (My dr is getting me samples for now).
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