Crohn's Disease Forum » Treatment » 5-ASA/Mesalamine » Insurance won't pay for Delzicol/Lialda/Pentasa

01-27-2014, 08:17 PM   #1
Join Date: Jan 2014
Insurance won't pay for Delzicol/Lialda/Pentasa

Hello everyone, I just joined because I don't know what to do. I found out today that my insurance, Blue Cross Blue Shield (they use Express Scripts, which used to be Medco, as their pharmacy division), won't pay for Delzicol, which I've been taking for 16 years. I checked and they won't pay for Lialda or Pentasa either. What am I going to do? The Delzicol I take is almost $400 a month! How can the insurance companies deny ANY treatment? Do they want me to just die because it would be cheaper for them? I waited all day to hear from my doctor's office but so far they haven't called. I don't know what they can do though, they can't force the insurance company to pay. I tried to find out if any other health insurance companies in our state would pay for this medication. So far I haven't been able to find out about all of them, but United Healthcare won't. (In the past, I have had both BCBS and United Healthcare and they DID pay for it - but that was in the past).

Has anyone ordered medications from Canada? I understand they have generic Asacol.

Thank you...
01-27-2014, 08:39 PM   #2
Senior Member
FrozenGirl's Avatar
I'm in Canada on Mezavant ( which is Lialda in the states I believe). Costs $230/ month if your are not insured. I'm sorry that wasn't much help but I thought I would mention costs so you have an idea if you are shopping around.
Dx: Ulcerative Colitis, Nov 2013
Currently on:
Mezavant 4.8g
Vitamin D 1000iu
Tecta 40mg
Remicade: 600mg, every 4 weeks
Methotrexate: 15 mg (injection)
01-27-2014, 10:06 PM   #3
Lisa's Avatar
Join Date: Apr 2010
Location: New York

My Support Groups:
What state are you in, that might help....

30 plus years and counting with UC/Crohn's!
on remicade since 11/05

While my experiences may not be what everyone has had- I feel it is worthwhile to share any and all experiences that may be beneficial to others.
01-27-2014, 11:44 PM   #4
Join Date: Jan 2014
I'm in Georgia. Thank you!
01-28-2014, 03:23 PM   #5
CLCH87's Avatar
Join Date: Jan 2013
Location: Orlando, Florida

My Support Groups:
There is a generic for Entocort, not sure if you've ever tried that. The generic only costs a couple dollars a month. Have you heard from your Dr yet?
01-29-2014, 02:47 PM   #6
Join Date: Jan 2014
Guess what, I found out today that my insurance will cover Apriso, which I have never taken but my doctor says it should be ok for me. If not, there is a way he can talk to my insurance company's "review board".

I am so relieved.
01-29-2014, 08:44 PM   #7
SarahBear's Avatar
Join Date: May 2012
Location: Charleston, West Virginia

My Support Groups:
Apriso is actually the same thing you're already taking (a mesalamine like Delzicol, Pentasa, etc.), so that's great! I'm glad you were able to find a solution. Insurance companies can be very difficult to deal with - I'll never understand why they can't just say, "We can't cover that medication, but we'll cover this one that is the same thing." It would save a lot of stress!

I'm glad things are working out!

Diagnosed with Crohn's disease 12/6/08.
Have taken: Prednisone, 6mp, methotrexate, Pentasa.
Currently waiting for a new medication!

Check out the Crohn's forum chat!

02-14-2014, 08:54 PM   #8
ruhereyet's Avatar
Join Date: Sep 2013
Location: Edmond, Oklahoma
I have Express Scripts and they covered Pentasa and Lialda at 100%. That's quite odd that they won't honor it for you. Have you called them to verify? Maybe the pharmacy didn't run it correctly. Or, maybe your employer won't cover it.
03-13-2014, 08:33 PM   #9
wingfam94's Avatar
Join Date: Mar 2014
Location: Lansing, Michigan
Did you take the Apriso? Did it work? United Healthcare won'tcover the Pentasa as you know and the sulfazine I'm on isn't working. Curious if Apriso is a possible solution.
03-13-2014, 08:49 PM   #10
I'm having the same problems. Except I'm not on anything right now except Prednisone 40mg daily, which I've been on for 3 months straight now. My insurance is BCBS too. Asacol, Lialda and Imrun don't work on me. Insurance has flat out denied Cimzia. Right now I'm waiting to hear back about Humaira. I have a case worker at my hospital that started helping me since my last hospital stay last week. She said that if insurance denies the Humaira then they are going to try to get me patient assistance since I'm a single mom of 4. She thinks I'll qualify if insurance denies coverage. Looks like I have to wait 15 days to find out. Also a friend of mine says you can file for an appeal against your insurance company. Hope you get something figured out.
03-14-2014, 02:03 PM   #11
Forum Monitor
tzvia's Avatar
Join Date: Mar 2012
Location: Philadelphia, Pennsylvania
As far as the Pentasa, the company that makes it has a program that might pay for it if you qualify. I get mine for free from them. Google "Shirecares Pentasa" and you'll see the info. Good luck!
Diagnosed with Crohn's in 2007, symptoms since 2000.
Hospitalized with bowel obstruction 8/2012
Ileocecectomy with 9" small bowel removed 10/2014

Current meds: Stelara, Entocort, Questran
Past meds: Prednisone, Humira

06-05-2014, 11:14 AM   #12
nogutsnoglory's Avatar
Join Date: Sep 2009
Location: New York

My Support Groups:
It's against forum rules and illegal to give medication. I would call the manufacturer and pharmacy about a refund, donation or disposal.
10-26-2014, 01:31 PM   #13
Join Date: Oct 2014
Location: Florida
Hello everybody. This is my first time posting in this forum. I have ulcerative colitis which is also treated with the same meds as Crohn's.

I also have Blue Cross Blue Shield and they rejected scripts for Asacol HD and Lialda. I had to end up in the hospital for treatment.

After doing research will these drug companies, I found that Shire (company that makes Lialda) has a form you can fill out if your insurance company rejects your prescription and you cannot afford to pay for these meds based on your income then you can apply at their website

by Googling patient support shire. (I can't put in the link)

ok...looks like somebody else put in the same information in the thread already.

Last edited by SMR; 10-26-2014 at 01:33 PM. Reason: adding information

Crohn's Disease Forum » Treatment » 5-ASA/Mesalamine » Insurance won't pay for Delzicol/Lialda/Pentasa
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