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Is Rowasa covered by your insurance (USA)?

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Ulcerative Colitis
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Posted 1/27/2011 10:08 PM (GMT -5)
I've never had this happen before but my new insurance just denied my Rowasa prescription and told me it wasn't covered under the plan. They said it's not FDA approved. I checked online and it was approved by the FDA in 1987.

I think they will cover the generic mesalamine enemas. That doesn't help me though because I need the new Rowasa SF without the sulfa preservative that I'm allergic to.

I need to look into this some more, but in the meantime, I thought I'd check with people here to see what your experience has been.

Have you had Rowasa denied by insurance?

It looks mighty pricey if I tried to just pay for it myself....
Posted 1/27/2011 10:15 PM (GMT -5)
Never had I ever been denied when I could use them.
Posted 1/27/2011 10:18 PM (GMT -5)
Rowasa is more money per month with my plan than generic but it is covered. I've always gotten the generic but if you can't tolerate the generic brand because of an allergy, they should give you the brand name. I hope you can get it covered. These enemas are so expensive without insurance.
Posted 1/28/2011 11:13 PM (GMT -5)
How up-to-date on IBD meds is your insurer's Rx formulary? Some of them are more limited than others as to which meds they cover. Period! Mine will only pay for brandname med if the doctor certifies on an annual basis that the generic was tried & did not work or caused a flare, etc. I'm wondering whether yours would pay some or all of the cost if your doctor supports your claim of allergy to sulfa in the generic. / Old Hat (30 yrs with left-sided UC; presently in remission taking brandname Colazal)
Posted 1/29/2011 11:20 AM (GMT -5)
My insurance covers both the brand and generic but I pay a really high co-pay for the brand and $10 for the generic. I have never tried to get the SF so I don't know. That's annoying that they won't give you the SF! >;o(
Posted 1/29/2011 11:41 AM (GMT -5)
was covered when I tried a few years ago, since have used the generic..but if you found that it is FDA approved, sounds like you got a bogus response, I'd try calling again, ask to speak to supervisor and explain why you need Rowasa and why it is different than the generic.. bummer you have to deal with this beaurocracy...it's not like we LIKE suspension enemas
Posted 1/29/2011 3:53 PM (GMT -5)
Mine is covered. Never tried the SF. I'd call the pharmacy back. Then call your doctor if the pharmacy and your insurance company still refuse to cover it to discuss options.
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