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Forum
-> Health & Wellness
-> Crohn's & Colitis
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amother
OP
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 Wed, Jun 17 2020, 9:12 pm
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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.
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amother
Royalblue
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Wed, Jun 17 2020, 9:18 pm
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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...
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amother
Sienna
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Wed, Jun 17 2020, 9:19 pm
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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
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amother
Yellow
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Wed, Jun 17 2020, 9:23 pm
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!
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dvoras
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Wed, Jun 17 2020, 10:09 pm
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
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amother
Black
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Wed, Jun 17 2020, 10:20 pm
| 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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