Insurance Question-ExpressScripts user

Often a medication within a given Tier costs the same flat dollar amount, regardless of the quantity you actually receive.

1.) You can ask your doctor to write you a prescription for a 3-month supply, rather than 1-month.

2.) When our dosage/frequency is reduced by the doctor, ask that they do not change your prescription at all: it will last you longer for the same copay price.

Exactly what iPoop said!

Over the years, I have several times asked a doctor to prescribe the max amount allowed for a three month period just so I could have an emergency stash in case my dosage suddenly needed to be increased, or in case I lost my job and therefore my insurance, etc.

I have Express scripts also, and everything cost me a lot more at the beginning of the benefit year than at the end when my deductibles and all that were met. My insurance year starts Dec 1, so everything "resets" today. But last week I got several things refilled and because out out-of-pocket costs had been so high this last year, my co-pays these last weeks were $0!

Nice, but.... weird.

Not sure on the lialda, how much are you willing to rock the boat? You could see if Lialda and it's generic are non-formulary and switch to an approved formulary.

1.) Ask which UC medications are on the insurance's formulary (preferred) list and which are on their non-formulary (not preferred) list. For the lowest out-of-pocket cost, choose from the formulary list.

2.) Generics are the most cost effective. Brandnames are more expensive.

3.) Use the health insurance's price estimator tool (online insurance website, or call insurance, or ask a pharmacy) to learn what your copay will be. You will need to know which medications are applicable. The most common UC meds used are the anti-inflammatory, mesalamine-based medications that should be available in their price estimator:

• Apriso is brandnamed, comes in 375mg pills, a typical dose is 1,500 mgs or 4 pills daily. A copay assistance card is available from the manufacturer.
  
• Balsalazide Disodium is generic of Colazal, comes in 750mg pills, a typical dose is 6,750mgs or 9 pills daily.
  
• Colazal is brandnamed, comes in 750mg pills, a typical dose is 6,750mgs or 9 pills daily.
  
• Delzicol is brandnamed, comes in 400mg pills, a typical dose is 4,800 mgs or 12 pills daily. A copay assistance card is available from the manufacturer.
  
• Lialda/Mezavant is brandnamed, comes in 1,200mg pills, a typical dose is 4,800 mgs or 4 pills daily. A copay assistance card is NO LONGER available from the manufacturer, discontinued on 11/1/2017 and will not be renewed into the next year.
  
• Mesalamine DR is generic, comes in 800mg pills (generic Asacol HD) and 1200mg pills (generic Lialda), a typical dose is 4,800mgs. That's 8 of the 800mg pills or 4 of the 1,200mg pills daly.
  
• Pentasa is brandnamed, comes in 500mg pills, a typical dose is 4,000 mgs or 8 pills daily. A copay assistance card is available from the manufacturer.
  
• Sulfasalazine is a generic,comes in 500mg pills, a typical dose is 4,000mgs or 8 pills daily.
  

It's possible that (for example) Pentasa is formulary and Lialda is nonformulary, and even on different tiers as a consequence thereof. The copay could be dramatically different.

If you are daring then you could always ask for a prescription for generic balsalazide disodium instead. It comes in 750mg pills, a typical dose is 6,750mgs or 9 pills daily. Certainly the copay would be waay less.

Zydus has an exclusive window to be the only generic for Lialda, and they are using it to charge a premium it seems ($20 less than Lialda for a 30-day supply which is pretty crazy for a generic). But it sounds like there is going to be more competition, Shire is going to have their own licensed-generic, and others might soon enter the fray. It's gotta open up more competition and push prices lower over the long term, I hope, *fingers crossed*.

Ty, all. Perhaps my doc would be willing to try a lesser med than Lialda, that would help much. Being on Remi for a few yrs now and being in remission mostly even longer, you'd think I could get by with less. I'll see how my scope looks this year.

My copay is 200 each for the 90day of liada and rowasa.