Crohn's Disease Forum » Treatment » 5-ASA/Mesalamine » Suppository coverage information


01-11-2019, 06:21 PM   #1
BoyMama2000
Senior Member
 
Join Date: Sep 2011
Location: Denver-Boulder, Colorado
Suppository coverage information

Hi Everyone,

After 12 years of great insurance coverage, we have had two big issues lately. Anthem Blue Cross denied coverage for hydrocortisone suppositiories saying this is a medication they just won't cover. We are out $850 there. Now they won't cover mesalamine suppositories 1,000mg.

Has anyone had problems getting them covered? If they were paid for, did they pay for mesalamine twice daily or just once?

His doctor now asked for mesalamine suppository and they denied asking for prior authorization which can take up to 8 weeks. Neither of these meds cost close to his Stelara injections that are every 4 weeks so I guess I should be glad they are covering that one.

His disease is controlled everywhere but his rectum. They wanted my son to add in methotrexate but he was on that before and won't take it again. The plan was to do the hydrocortisone supp for 8 weeks while metho took time to work. The second plan was to do the hydrocortisone and then move to mesalamine suppositories.

We see the doctor again February 1 and were planning to have him on suppositiories until that time and then discuss again other options.

Thanks.
01-12-2019, 09:56 PM   #2
Maya142
Forum Monitor
 
Maya142's Avatar
I'm going to tag some other parents who may know more than I do:
crohnsinct
my little penguin
pdx
Clash
kimmidwife

Can you have the doctor appeal? We haven't had this issue with suppositories but we have with other meds. I've found in the past I had to be very persistent to move the process along - first for the doctor to appeal, then the insurance company to figure out whether it had been approved, appeal again, if that fails then a peer-to-peer review. In some cases, it has taken months, but we have gotten very expensive meds covered, once we proved they were medically necessary.

Instead of MTX, could they increase his dose of Stelara to see if it'll control the rectum?
__________________
Mom of M (20)
diagnosed with Crohn's Disease at 16
Juvenile Idiopathic Arthritis at 12
Juvenile Ankylosing Spondylitis at 16

Mom of S (23)
dx with JIA at 14
Ankylosing Spondylitis at 18
01-12-2019, 10:56 PM   #3
crohnsinct
Senior Member
 
Join Date: Mar 2012
Location: California

My Support Groups:
Your son seems to be in the exact same boat as my older daughter O (her thread is Heard from Doctor or is it Heard from GI? I am getting old anyway it is in the parents section).

Her hydrocortisone suppositories were also not covered. We were desperate and paid out of pocket using Goodrx and were able to get maybe a 3 week supply for $250 (without goodrx they were $450) while we waited for all the insurance issues to get resolved. We are currently appealing.

Our denial came in as "no rectal suppositories are covered", so our GI is asking if enemas or foams would be covered and if so we may switch to those.

My daughter was also prescribed oral budesonide and that was denied as well. My daughter was on Mtx a while ago and it really didn't do anything for her rectum. Her and I are now wondering if oral mesalamine might be worth asking for. I know it is usually used for UC but if the rectum is the problem area then maybe it will work for our Crohnies?

BTW - the rectal suppositories work like a charm for her. If she skips a dose she immediately feels the effects. They were a total game changer for her.
__________________
Daughter O dx 2/1/12 at age 12
Crohns & Remicade induced Psoriasis
Remicade
Vit d 2000IU
Multi vitamin plus iron
Calcium

Previously used - Prednisone, Prevacid, Enteral Nutrition, Methotrexate oral and injections, Folic Acid, Probiotics, Cortofoam

Daughter T dx 1/2/15 at age 11
Vitaligo, Precoscious puberty & Crohn's
Remicade
Vit D 2000IU

Previously used, Exclusive Enteral Nutrition, Methotrexate (injections and oral), Folic Acid, Entocort,IBD-AID Diet
01-14-2019, 06:13 PM   #4
OrlaRi
 
Join Date: Aug 2018
Location: Mullingar, Ireland
Hi All,

My 7 year old was diagnosed with Crohn’s in August. She’s now on weekly MTX jabs which solved all symptoms except bleeding from rectum. She has also been put on nightly mesalamine suppositories for 2 weeks & we’re at day 7 of that. They seem to be helping. Fingers crossed it’ll continue to do the trick for her.

HTH
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