Dear Team,
I have been taking Uceris for the past 30 months for my collagenous colitis. For me, it works significantly better than Entercort EC. Unfortunately, I have been unable to get into any remission for more than two weeks off of the drug.
My company recently switched from Blue Cross of CA to Blue Shield of CA. Unfortunately, Uceris in NOT on the drug formulary for Blue Shield. As such, my doctor submitted an application for an exception to their drug formulary. The claim was denied. The response letter from them said that Uceris is only for UC, and there is not any indication that I have UC. If I would like to appeal, they say I need to show evidence that I have UC or show two articles in a peer reviewed journal that show Uceris is effective in the off label treatment of CC. I don't believe there are any articles out there that show this.
Terrified of having to go off of Uceris. Any thoughts on how to proceed?
Your help is greatly appreciated.
Sincerely,
Jim Watson
Celiac disease (2012), CC (2013). Diet: avoid: gluten, dairy, soy, corn, all grains, potato, sweet potato, quinoa.
Uceris daily. 3mg LDN daily.
Blue Shield has denied use of Uceris....please help
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jimjwatson
- Posts: 2
- Joined: Tue Feb 04, 2014 10:52 pm
- Location: San Francisco
Blue Shield has denied use of Uceris....please help
Diagnosed with Celiac Disease in April 2012. Diagnosed with LC in August 2013.
Hi Jim,
Welcome to our Internet family. Your insurance company is ripping you off. Uceris is commonly prescribed to treat MC, but Blue Shield has you between a rock and a hard place with their requirements for exception approvals because as you say, there are no qualified articles in medical journals that expressly approve Uceris for off-label use to treat MC, nor will there ever be because no drug companies are willing to spend the money to do the research. They are convinced that MC is a rare disease because that was declared in old, obsolete (incorrect) medical articles and once a medical "fact" is published, it is rarely withdrawn or updated. In fact, MC is more common then Crohn's disease, UC, or celiac disease, but that's irrelevant as long as the drug companies continue to ignore the disease.
The sad fact of the matter is that there is not a single medication that is actually labeled to treat MC. And Uceris is a relatively newly-approved medication, so there has not been sufficient time for studies on off-label uses (such as for treating MC) to have been carried out and published. So in view of that fact, exactly how does your insurance company expect you to treat the disease? Is there any way that you can bounce that question off their hard skulls? You might ask your GI specialist if she or he is aware of (or can look up) any studies currently in progress for off-label uses such as this.
I see that you are avoiding many foods already. I wonder if you might be sensitive to certain meats or nuts in your diet. Have you had the EnteroLab test for the 11 additional antigenic foods? Many of us are sensitive to pork, chicken, beef, certain fish, and nuts.
While I can tell you where you can order a generic substitute for Entocort for less money than most copays here in the U. S., I'm not aware of a cheap source of Budesonide (UCERIS) Extended-release tablets (or a generic knock-off), unfortunately.
Ever since it's original description, roughly 40 years ago, MC has been treated like the red-headed stepchild of the IBDs. GI specialists are slowly learning more about it, but the drug companies and many insurance companies remain slow to change.
I wish that I could be more helpful, but as you are well aware, these days insurance companies dictate medical treatments. They have somehow managed to usurp that authority from physicians, which is a pathetic situation, to say the least. Again, welcome aboard, and please feel free to ask anything.
Tex
Welcome to our Internet family. Your insurance company is ripping you off. Uceris is commonly prescribed to treat MC, but Blue Shield has you between a rock and a hard place with their requirements for exception approvals because as you say, there are no qualified articles in medical journals that expressly approve Uceris for off-label use to treat MC, nor will there ever be because no drug companies are willing to spend the money to do the research. They are convinced that MC is a rare disease because that was declared in old, obsolete (incorrect) medical articles and once a medical "fact" is published, it is rarely withdrawn or updated. In fact, MC is more common then Crohn's disease, UC, or celiac disease, but that's irrelevant as long as the drug companies continue to ignore the disease.
The sad fact of the matter is that there is not a single medication that is actually labeled to treat MC. And Uceris is a relatively newly-approved medication, so there has not been sufficient time for studies on off-label uses (such as for treating MC) to have been carried out and published. So in view of that fact, exactly how does your insurance company expect you to treat the disease? Is there any way that you can bounce that question off their hard skulls? You might ask your GI specialist if she or he is aware of (or can look up) any studies currently in progress for off-label uses such as this.
I see that you are avoiding many foods already. I wonder if you might be sensitive to certain meats or nuts in your diet. Have you had the EnteroLab test for the 11 additional antigenic foods? Many of us are sensitive to pork, chicken, beef, certain fish, and nuts.
While I can tell you where you can order a generic substitute for Entocort for less money than most copays here in the U. S., I'm not aware of a cheap source of Budesonide (UCERIS) Extended-release tablets (or a generic knock-off), unfortunately.
Ever since it's original description, roughly 40 years ago, MC has been treated like the red-headed stepchild of the IBDs. GI specialists are slowly learning more about it, but the drug companies and many insurance companies remain slow to change.
I wish that I could be more helpful, but as you are well aware, these days insurance companies dictate medical treatments. They have somehow managed to usurp that authority from physicians, which is a pathetic situation, to say the least. Again, welcome aboard, and please feel free to ask anything.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.