prescription plan no longer covering medication-what to do?

[Anonymous]

Takeda Patient Assistance program

https://www.takeda.com/en-us/what-we-do/patient-services/helpathand/

At Takeda, we believe all patients should have access to the medications prescribed by their healthcare providers. We also understand that some patients may have financial situations that make it difficult to pay for their prescriptions. Help at Hand (the Program) provides assistance for people who have no insurance or who do not have enough insurance and need help getting their Takeda medicines. All applications are reviewed on a case-by-case basis in accordance with program criteria.

To be eligible, you should:
Be a resident in the United States
AND
• Not have health coverage, or not have enough coverage to obtain your Takeda medication
• Have a household income equal to or less than 5 times the Federal Poverty Level (for more information on Federal Poverty Levels, visit https://aspe.hhs.gov/poverty-guidelines
• Not have access to alternate sources of coverage or
• Have recently lost your job and are experiencing financial hardship

A family of four ins DC the poverty level is $27,750 so five times that is $138,750. just to give you a sense of it you would qualify.

[Anonymous]

Anonymous wrote:I am a public school teacher in MCPS. I have an autoimmune disorder and have successfully been in remission since taking a medication for the last decade. I got a notice that this medication will no longer be
covered as of July 1. There is no generic version of my medication and I have unsuccessfully tried 2 out of the 4 alternative medications the insurance policy is offering instead. Buying the medication out of pocket will cost $1500 a month which would be very
tough on my salary. My doctor wrote an appeal letter but it is possible that the appeal may be denied or that the process will take long beyond when I run out of my medication. The benefits director for MCPS is saying that he can't do anything to advocate for me.
Is there anything else I can do? Without the medication, I will have cramping, diarrhea, intestinal inflamation, etc. and it will be difficult to do my job

Have you tried talking to the state mediation program?

https://www.marylandattorneygeneral.gov/Pages/CPD/Tips-Publications/edge75.aspx

[Anonymous]

marc cuban's new pharmacy has generic Mesalamine Extended Release.

375mg 30 capsules = $36.60

Mesalamine is a prescription drug indicated for the induction of remission in patients with active, mild to moderate ulcerative colitis, and for the maintenance of remission of ulcerative colitis. Mesalamine is available under the following different brand names: Asacol HD, Pentasa, Delzicol, Lialda, and Apriso.

https://costplusdrugs.com/medications/mesalamineextendedreleaseer-375mg-capsule

[Anonymous]

Anonymous wrote:marc cuban's new pharmacy has generic Mesalamine Extended Release.

375mg 30 capsules = $36.60

Mesalamine is a prescription drug indicated for the induction of remission in patients with active, mild to moderate ulcerative colitis, and for the maintenance of remission of ulcerative colitis. Mesalamine is available under the following different brand names: Asacol HD, Pentasa, Delzicol, Lialda, and Apriso.

https://costplusdrugs.com/medications/mesalamineextendedreleaseer-375mg-capsule

The online pharmacy is called cost plus drugs and it is reputable.

https://www.washingtonpost.com/opinions/2022/02/02/mark-cuban-cost-plus-drug-prices/

[Anonymous]

Op here- I am so grateful for everyone's suggestions!!

[Anonymous]

Anonymous wrote:Does Kaiser cover the medication? I'd switch to Kaiser. We had Kaiser years ago when I was pregnant (2 deliveries) and had little kids. We only had good experiences.

It's annoying to me how insurance companies can override a doctor prescribing medications. Our insurance won't cover my name brand thyroid medication anymore, only generic. This is extremely frustrating to me as the generics are proven to not be as effective as their quality control is horrible. I suck it up and pay the cost for the name brand.

I am in the same position with my insurance refusing to cover Synthroid. I saw on the Synthroid website that they have a discount program for the medication. I’m going to look into it.

[Anonymous]

It should not be this hard to get the drugs that your doctor prescribes. So glad to see all the thoughtful posts.

[Anonymous]

But the generic was just approved a week ago - which is why CVS isn't going to cover the brand anymore. Are they saying they won't cover the generic either?

[Anonymous]

Yes the generic is not covered

[Anonymous]

Mesalamine is the generic? it's $200.

[Anonymous]

OP here of this post from last year...I appreciated everyone's input so much when I was going through this. I was able to get the insurance company (cvs/caremark) to cover the Pentasa last year through my doctor's prior authorization letter. However, they denied the prior authorization letter this year- In the denial letter, they reported that they want me to try the generic, Mesalamine ER or Sulfasalazine (which I have tried in the past twice-the first time, it resulted in my crohn's not being full managed and the second time I tried it later in life, I broke in hives and am now considered allergic to it). I was really upset that the generic does not work for me--I have tried two different ten day trials of the generic Mesalamine ER, last year, and my Crohn's symptoms emerge with bloating, diarrhea, abdominal discomfort. As soon as I return to Pentasa, I feel great again. I have tried 7 different crohn's meds over my lifetime--and the stomach wants what it wants

- My doctor will write a medical exception letter and their office will file the appeal I guess I need to pray that it will be approved. I think I'm just venting but let me know if you have any words of wisdom.

My insurance company will not count the prescription cost towards our individual/family maximum, if I need to pay out of pocket ($1,500 a month). Unfortunately, we make too much to qualify for any patient assistance. I am going to seriously look into canadian pharmacies again as a backup. My union and benefits department won't get involved unfortunately.

[Anonymous]

Obamacare Marketplace?

[Anonymous]

My husband and daughter have crohns and we have been fought for 3 different biologics now and it was approved eventually. I’m surprised they aren’t covering pentasa- isn’t this an old treatment for crohns? I think my husband was on this decades ago.

[Anonymous]

I found a lowest price on Costco for a medication that cost $400 for 90 day supply at Walgreens using my insurance and $93 at Costco for the exact same rx without using insurance. Good Rx also had a much lower price but not as low as Costco. I don't have a Costco membership and I get it mail order.

This probably won't help OP with her seemingly complicated med issues but might help others with similar problems.

[Anonymous]

Anonymous wrote:My husband and daughter have crohns and we have been fought for 3 different biologics now and it was approved eventually. I’m surprised they aren’t covering pentasa- isn’t this an old treatment for crohns? I think my husband was on this decades ago.

Op here- I'm one of the few lucky ones that my doctor has encountered who have responded exceptionally well to a low level of medication like pentasa- maybe because of the location of my Crohn's. The pentasa is much cheaper for insurance than a biologic. But still much more expensive than the generic that came out.

I did look at good rx but unfortunately didn't find anything below around $1,450-1,500 a month. I can still check Costco just to make sure it's not cheaper