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Suppository Coverage and Outcomes

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. He hated the side effects. The pfirst lan 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.