Hi all. Been a while since I've posted here. I've had chronic antibiotic-dependent pouchitis for about 3 or 4 years now following my 2004 colectomy. After much experimentation with different medicines, my doctor and I finally settled on Xifaxan, which has been very helpful. After being on it for about 2 and a half years now, Cigna has told me they won't cover it any longer. I've already filed 2 appeals, both of which were denied. This is really the only medicine that helps keep me in remission, so I'm very concerned at this point. Any suggestions?
Original Post
I don't really have any suggestions other than to keep bugging the insurance company. I've noticed that at some point they figure the time they're expending in denying your request becomes counter-productive or they start losing money. It's almost like they have a big hourglass on their collective desk and when that last grain of sand falls they say, 'um, okay, we'll cover that for you.' And why couldn't they just agree to that from the start?

kathy Big Grin
My insurance company covers it, but with a higher co-pay ($40). Cipro and flagyl are $15 co-pays each. To me, they should increase the co-pay, maybe, but not pull the plug on coverage.

What was your copay on Xifaxin before the coverage was terminated?
Have you had your doctor file an appeal? It took my doctors office 3 times to get Humira covered for me, but the insurance finally gave in. Having a doctor fighting for you may pull some strings.
My doctor filed both of the first two appeals for me. I've heard from a few people that the third time is often the charm, so I have my fingers crossed.
In the past I have filed appeals on similar issues, involving out of network coverage vs. in network coverage etc. Persistence frequently pays off in these situations. Good luck Drew and let us know what happens.
Yea this is new with this drug. They are also covering it weird. My GI writes the script for 30 days treatment and double the strength. I use it for 2 weeks then save the rest for 2 weeks the following month then repeat. I was able to get it on a 2 refill max now I have to call in for the refill. Mine is still covered though with no copay just different rules. This drug is the least effective though for me. I have to combine it with other antibiotics.
I just picked up my first prescription of xifaxin. 120$$$$$$....only two weeks worth! My husband got it so he didn't ask about insurance. I can imagine this costing any more so maybe its not covered? I'll have to call and find out. Ouch!
Have you tried applying to the drug company? You just need a written prescription from your doctor. It certainly wouldn't hurt to try. They do give out a certain amount every year and often they don't give out all they can. It isn't always based on ability to pay. I got my Effexor that way when I didn't have insurance.
I am in shock...I called my pharmacy today to see if any of the prescription was covered by insurance. BCBS paid $486 of the total cost!! I paid $120. So for 14 pills, it was $600!!! Oh my. I guess this is not one I will be able to afford to stay on for very long!

Samantha offers good advice. Give the manufacturer of Xifaxan a call; I believe it is Salix Pharmaceuticals, but you can double check by looking at your prescription bottle. I believe they have a patient assistance program that can help people who cannot afford medication when their insurance doesn't cover it. I think you have to have less than $50,000 in assets to qualify. It's certainly worth investigating if the drug has given you so much benefit.

Um that's $42 a pill!! Not that you couldn't do the math.

I would still try the drug company and see how much they ask about ability to pay. In my case I don't remember them asking.

I would also try a personal appeal to them. It doesn't hurt to try. Tell them your life depends on it. These are tough times. They are obviously ripping people off. Maybe they will give it to you if you promise not to call 60 Minutes and tell them about it.
Hi all. Just wanted to provide an update on my Xifaxan issue. After 3 appeals (2 letters from my doctor and a conference call involving my doctor, a Cigna review team and myself) my prescription was approved for one year. I had heard that the third time is often the charm in these reviews, and luckily that turned out to be the case. Start to finish the whole ordeal lasted about 6 or 7 stressful weeks. But I guess all's well that ends well.

My doctor prescribed Pentasa for me during my Xifaxan hiatus, and it surprisingly worked pretty well. I also continued my daily shots of Pepto Bismal extra strength. I do one shot a day as a maintenance regimen, and two a day when things get rough.

As a side note, I was just prescribed doxycycline for an unrelated issue, and I'm noticing that it's working wonders for my pouchitis. Doxycycline was one of the few antibiotics I hadn't tried for my pouchitis, and it's nice to know that it's another option now if something else becomes ineffective (like Cipro did).

Add Reply

Copyright © 2019 The J-Pouch Group. All rights reserved.
Link copied to your clipboard.