New insurance won't cover crohn's meds.

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Forum -> Health & Wellness -> Crohn's & Colitis

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amother

Thu, Jun 18 2020, 12:12 am

I've been taking a medication called pantasa to manage my crohn's disease for many years. My employer switched insurance companies a few weeks ago and I just found out they won't cover my pantasa and instead they want me to try a different medication. If after some time my disease is getting worse while using the alternative medication, then they'll cover my usual meds. My regular meds cost around $800 a month. My doctors office said they'll call and fight but are not hopeful. Any ideas appreciated.

amother

Royalblue

Thu, Jun 18 2020, 12:18 am

Maybe you can buy your own insurance with employer just giving you some $ toward it. Or try to get Medicaid as they cover most meds...

amother

Sienna

Thu, Jun 18 2020, 12:19 am

I have arthritis and my dr told me that insurance can't change meds once something is proven effective (not sure how it works if you're actually switching insurances) he wrote me a letter for them and fought for me. I was switching medicaid to a different state when I moved

amother

Yellow

Thu, Jun 18 2020, 12:23 am

You can be grandfathered in to taking that drug. You have a case. Call the insurance company and tell them you've been taking this medication for x time, and if you absolutely cannot afford a flare up from changing meds. Ask what the process is for working this out. There might be forms, something your doctor might need to help with.
Good luck!

dvoras

Thu, Jun 18 2020, 1:09 am

Contact me. I had the same story. Was on pentasa for years, switched insurance dr. Tried 5 times to get it approved. Didnt work.
Ended up switching to apriso, which works even better, there is also lialda which is very good. PM me for more info

amother

Black

Thu, Jun 18 2020, 1:20 am

amother [ Royalblue ] wrote:

Maybe you can buy your own insurance with employer just giving you some $ toward it. Or try to get Medicaid as they cover most meds...

Medicaid is government sponsored insurance for indigent people who would not otherwise have health insurance. People cannot just sign up for Medicaid. As a healthcare provider I have seen that it is true that they provide much better service than what I get for about $20,000/ year, but it would not be ethical or legal to get Medicaid, especially when her place of employment provides health insurance, even if it stinks.

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