I had the same issue with insurance and VSL3. I got my doctor to write me a note for VSL3DS (prescription required) and why I needed it to treat active pouch inflammation and my husband fought this with his insurance (I am covered through his employer). They are now covering the prescription so you may be able to take this approach.
As far as pouch inflammation goes, my surgeon has always told me almost all patients have some active inflammation in their pouch (some may be asymptomatic though). Many do not even know it. I have pouchitis in my distal pouch and it really is not causing me any active symptoms at the moment and I have been off antibiotics for over 2 weeks (first time in 2 years).
The biopsies should indicate the level of inflammation and treatment will depend on that and the symptoms you are having. If you are
not in the bathroom as often with over the counter meds, that is probably helping your symptoms, but the inflammation may still be active in the pouch, and that they will try and treat most likely with a short course of antibiotics.