prescription plan no longer covering medication-what to do?

[Anonymous]

This is one of the most helpful posts I’ve seen on DCUM. Good job, people! And good luck OP!

[Anonymous]

Anonymous wrote:

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

Sorry. I hate insurance companies and their selfishness and the nerve they have to deny medications. We have gone weeks and many fights to get the biologics approved. Every single time we change a dose, frequency or med.

[Anonymous]

OP here-- The appeal went through successfully and I got notified by insurance that I am approved for another year to receive Pentasa Thanks for everyone's support/suggestions!

[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

you file a second appeal and then file for a independent review by someone outside of the insurance company

[Anonymous]

Anonymous wrote:OP here-- The appeal went through successfully and I got notified by insurance that I am approved for another year to receive Pentasa Thanks for everyone's support/suggestions!

Congratulations and thanks for following up!

FWIW, I once got a one year appeal reversal and they never blocked the prescription or asked for paperwork ever again. It was a de facto permanent approval (not one year). Hopefully you get similarly lucky!