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Dropped by Insurance: Will Your IBD and Ulcerative Colitis Drugs Be Covered in 2014?

by The GoodRx Pharmacist on December 4, 2013 at 2:00 pm

Express Scripts and Caremark have removed certain medications from their formulary starting in January 2014. These companies handle prescription benefits for more than 200 million Americans, so your prescription coverage will likely be changing in the new year.

We’re reviewing which prescriptions will no longer be covered and the suggested alternatives to give you a better picture of your options. Caremark has made a change in their coverage of inflammatory bowel disease (IBD) and ulcerative colitis meds that may affect you:

Removed medication: Asacol HD   ||   Suggested Alternatives: Apriso, Lialda, Pentasa, balsalazide, sulfasalazine, sulfasalazine DR

Recently, the manufacturer of Asacol discontinued their 400mg dose and replaced it with Asacol HD. Most Asacol patients at that time were converted to the Asacol HD. Now if your prescription insurance is handled by Caremark, you will need to be converted once again to a different product. The suggested alternatives Lialda, Apriso, and Pentasa all contain the same active ingredient as Asacol HD (mesalamine). However, doses and directions will now be different depending on which product you and your doctor decide is right for you.

Several of the brand name alternatives have savings or patient assistance available from the manufacturer as well—you can find the Lialda discount here, the Apriso discount here, and the Pentasa assistance page here.

If you’re taking one of the removed drugs, what should your next steps be?
•  Find out which company handles your prescription coverage. You can often check online, or call the number on your insurance card for more information.

•  If Caremark handles your coverage, double check the Caremark exclusion list to review the removed medications and alternatives.

•  If your prescription won’t be covered next year, contact your doctor or healthcare provider and explain that your pharmacy coverage has changed and that there is a suggested alternative for your current medication.

•  You and your doctor can then decide which alternative to try, or whether to explore other options for coverage.

What if you can’t / don’t want to switch to the covered alternative?

Particularly for specialty pharmacy prescriptions, there are assistance programs out there that may be able to help if your prescription is no longer covered by your insurance plan, and switching isn’t an option for you. Organizations like the Partnership for Patient Assistance and NeedyMeds can help you find which programs you’re eligible for.

Check the official website for your medication. In addition to prescription savings cards, the manufacturer will often offer a patient assistance program. You must meet income requirements or be uninsured for some programs, but others can help if you don’t have coverage for a particular drug.

If all else fails, it never hurts to ask to see if your prescription can still be covered. Have your doctor write a note, plead your case, make some noise – we’ve heard about coverage exceptions for some patients.

One last option: if you’re able to change your insurance plan, many of the drugs excluded by Express Scripts are covered by Caremark and vice versa. If you can find a plan that works for you with the prescription benefit offered by a different company, you may be able to keep your coverage.

The GoodRx Pharmacist

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