Insurance coverage can be confusing, especially when it comes to figuring out if your necessary medications are covered.
Sutab is an FDA-approved colonoscopy preparation tablet, that surprisingly falls outside the umbrella of many insurance plans.
There are different reasons why coverage may not be available for certain medications. These reasons may include how the medication is classified by insurance companies, how much it costs, and whether there are other options available.
In this article, we explore the complexities of insurance policies and coverage decisions, specifically looking at the case of Sutab. We’ll also explore alternative strategies such as patient assistance programs, discount coupons, and price comparison tools to help reduce out-of-pocket costs for those in need.
Sutab is an osmotic laxative that helps clean the bowel before a colonoscopy by causing bowel movements. It works by drawing a lot of water into the colon, which leads to watery bowel movements. This helps the doctor get a clear view of the colon wall during the procedure by removing stool from the intestines.
Unlike traditional liquid preparations, Sutab comes in tablet form, which many patients find more convenient.
Even though Sutab has been approved by the FDA and is easy for patients to use, it still faces challenges in getting insurance coverage. This is because it is considered a new option compared to existing methods that are already covered.
This classification impacts how insurance companies perceive its necessity and, by extension, its eligibility for coverage.
What is it used for
Sutab is prescribed by healthcare professionals to prepare patients for a colonoscopy. It ensures thorough cleansing of the colon.
Having a well-prepared bowel is important for accurately finding and removing polyps in the intestines. If left untreated, these polyps can sometimes lead to colorectal cancer.
Sutab is helpful for patients who struggle with drinking or don’t like the taste of liquid prep solutions. It comes in pill form, providing an alternative for colonoscopy preparation.
It’s a big step forward in improving gastrointestinal health by possibly making patients more willing to do regular screenings.
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Side effects of Sutab
While Sutab is effective in preparing patients for a colonoscopy, it does come with potential side effects.
Common side effects include:
- Nausea
- Vomiting
- Abdominal pain
- Bloating
- Diarrhea
- Sore rectum from frequent bowel movements
Less common, but more severe, side effects might include:
- Allergic reactions: itching, rash
- Dehydration
- Disturbances in electrolyte
If you experience signs of dehydration or electrolyte imbalance like feeling dizzy, fainting, having a fast or irregular heartbeat, severe vomiting, a headache, or a seizure, be sure to inform your doctor immediately.
Inform your doctor immediately if you experience any serious side effects, including: signs of kidney problems like changes in urine output, severe stomach pain, bloody stools, or rectal bleeding.
Why is Sutab not covered by most insurance companies?
Although Sutab offers an innovative way to prepare for colonoscopy, it still faces significant challenges when it comes to insurance coverage.
Understanding how insurance decisions are made can be complex, as there are multiple factors that determine whether a medication like Sutab is covered by insurance.
Let’s discuss why most insurance companies choose not to cover Sutab and what this means for patients who could benefit from this preparation method.
5 Reasons why Sutab is not covered by insurance
1. FDA Approval Does Not Guarantee Coverage
The FDA approves a medication based on how safe and effective it is, not how much it costs or how it compares to other treatments. However, insurance companies consider costs and how it benefit their policyholders when deciding what to cover.
Even though Sutab is approved by the FDA, insurance companies might not think it much better than cheaper, well-known alternatives. In the eyes of insurance, if an existing and less expensive method has been effective, a newer, more costly alternative may not be necessary.
This means that even though a product like Sutab can be convenient and offer potential compliance benefits, these factors alone might not be enough to justify including it in the list of covered medications.
2. High Cost Relative to Alternatives
Sutab is a new product in the market and is more expensive than similar liquid options. This is because it comes in a convenient tablet form and requires significant research and development.
Insurance companies often provide coverage for the least expensive option that is clinically effective. We all know that liquid preparations for colonoscopy are widely available and much cheaper. However, insurers tend to lean towards these traditional methods instead of pricier alternatives like Sutab.
The high price point of Sutab thus becomes a barrier to coverage as insurance companies weigh the benefits against the additional costs incurred.
3. Lack of Established Preference Among Patients and Physicians
Sutab is a more convenient option for preparing for a colonoscopy, but insurance companies often base their coverage decisions on past data and established preferences for medications.
Both patients and physicians may not be quick to shift from known and tried methods to new medication, especially when the existing ones are considered to be more effective.
So, the main reason could be that people hesitate to change, which leads to a lack of demand for insurance companies to cover new options like Sutab.
Additionally, if patients and doctors don’t strongly support these new drugs, insurance companies won’t feel the need to negotiate coverage or pricing for them.
4. Limited Evidence of Superiority Over Existing Preparations
Despite Sutab’s FDA approval, insurance companies usually demand substantial evidence showing its superiority over cheaper alternatives before providing coverage.
The evidence would need to show that Sutab is not just as effective, but more effective, or that it offers significant additional benefits (like increased patient compliance or better outcomes).
Currently, there may not be enough available studies or data comparing Sutab directly with traditional liquid preparations in terms of its impact on patients.
Without this evidence, insurers are hesitant to cover a new and more expensive product when there is already a less costly option that is well-established and effective.
5. Insurance companies lack motivation to negotiate discounts.
Sutab might face difficulties in getting coverage because insurance companies don’t have much motivation to negotiate lower prices.
Usually, insurance companies get big discounts on medicines by choosing them as the preferred option among similar treatments.
Due to Sutab’s higher cost, insurance companies may hesitate to negotiate prices unless there is a strong demand from doctors and patients.
Without a strong demand from the market or a clear advantage, the maker of Sutab has fewer chances to make a deal that benefits both insurance companies and their customers. As a result, without affordable pricing agreements, Sutab is not covered by most insurance plans, making it less accessible to a larger group of patients.
How much does Sutab cost?
The price of Sutab can vary depending on different factors. Some things that can affect the price you’ll pay include:
- Your insurance coverage
- The pharmacy you use
- Whether Sutab has a savings program (refer to the “Financial and insurance assistance” section below)
- Your treatment plan
To know how much Sutab will cost you, talk to your doctor, pharmacist, or insurance provider. Or check below in the next section to see how much you can save with an Optum Perks coupon.
The price for Sutab colonoscopy preparation can vary. On average, it ranges from $150 to $190 for a complete course. Prices can fluctuate, and patients can save money by using manufacturer coupons, patient assistance programs, or comparing prices at different pharmacies.
Also Read: How To Get Mounjaro 12 Month Coupon?
How to get Sutab at a cheaper price?
Here are some companies and sites that offer discounts and assistance programs for people using Sutab:
1. Peak Gastroenterology Associates
Peak Gastroenterology Associates are known for offering top-notch medical care in the area of digestive health that you can rely on. They are a highly specialized group of practitioners that focus on colonoscopy among other services.
Based on their association programs, they mentioned you can pay as little as $40 on your prescription. With the card they offer, patients can take it to their pharmacist to save on SUTAB® tablets. You can check it here
Based on their terms and conditions:
For normal Patients: Present this card with a valid prescription for SUTAB® at your pharmacy. Commercially insured patients save up to the program maximum after paying $40. Cash patients save up to the program maximum after paying $75. Additional amounts are your responsibility. Offer limited to one use and is not transferable. Call 1-844-926-4140 for questions.
For more information, visit their website here.
2. GoodRx
GoodRx is a drug pricing website that allows users to compare prices for prescription drugs at pharmacies in their area.
They offer coupons to save money on Stuab at almost 9 pharmacies, including Walmart. With their coupons, you can pay as low as $139.52 for 24 tablets of 1.479g/0.225g/0.188g. You can check out their price comparison and coupons here.
3. Optum Perks
Optum Perks is another pharmacy discount program that gives you free coupons for prescription drugs at more than 60,000 pharmacies in the US. They also have a tool to compare prices and find the best deals near you.
With their coupon, you can save up to 80% on Sutab at participating pharmacies. For example, for 24 tablets of 1.479g/0.225g/0.188g, the price can range from $146 to $174 with an Optum Perks coupon compared to the average cash price of $190.
You can visit their site here for more information
4. SUTAB® MEDICARE part D Alternative Savings Program
For patients who are under Medicare Part D, accessing Sutab at an affordable price can be challenging due to the varying coverage of prescription drugs.
If your prescription drug insurance for Medicare doesn’t cover SUTAB® or if your out-of-pocket costs are more than $50* for your Medicare Part D prescription of SUTAB®, Braintree Laboratories, a division of Sebela Pharmaceuticals, might be able to assist you.
With this program, you don’t need to ask your Medicare provider for reimbursement for your SUTAB® prescription costs. Instead, you can use this Medicare Part D Alternative Savings Program. This program won’t affect your current insurance plan.
Your Medicare Part D plan stays the same. To sign up for this savings program, just follow the 3 steps in the instructions that come with your card.
Visit here to fill in all the required information and agree to the statements to download your card.
Common Questions about Sutab and Insurance
Is there any insurance that covers Sutab?
Insurance coverage for Sutab can vary depending on your plan. Some insurance companies may consider Sutab as non-preferred due to its higher cost compared to other colonoscopy preparations. However, there may still be a chance for coverage under certain circumstances.
To find out about coverage for Sutab, it’s best to contact your insurance provider directly. You can also talk to your healthcare provider about cost-effective alternatives for colonoscopy preparation that your insurance may cover.
Is Sutab covered by Medicare?
Whether or not Medicare covers Sutab depends on the Part D plan that a patient has. Each plan has its own list of covered drugs, which can change every year. Patients are advised to check their plan’s drug list or talk to a Medicare representative to confirm if Sutab is included in their coverage.
You might also have to get approval before your insurance will pay for this medication.
Note that while Original Medicare (Part A and Part B) does not usually cover prescription drugs, Medicare Advantage Plans (Part C) may offer additional benefits, including drug coverage that could encompass Sutab. Patients should review the details of their Medicare Advantage Plan or consult with their plan provider.
How much does Sutab cost with or without insurance?
The cost of Sutab with insurance will vary based on your specific plan. Under insurance, you may have to pay a co-pay, which can range from $0 to a percentage of the drug’s cost.
Here are a few things that might impact how much you’ll pay for this medication if you don’t have insurance:
- Whether you qualify for any savings programs
- Your prescribed dosage and treatment plan
- The quantity of medication you need
- The pharmacy you choose to get your medication from
Without insurance, Sutab can be expensive, usually costing around $150 to $190 as mentioned before. However, patients can often lower this cost by using patient assistance programs, manufacturer discounts, and pharmacy comparison tools. In some cases, the price can be reduced to less than $100.
These factors may also impact the cost of Sutab with insurance coverage. However, the actual price you pay will be determined by:
- the benefits of your specific plan
- any requirements for prior authorization for drug coverage that you have.
Before filling your prescription, make sure to check with your insurance provider about coverage for Sutab. Additionally, you can also ask your pharmacist for assistance in finding the best price for this medication.
What alternatives to Sutab are generally covered by insurance?
Insurance plans often cover a variety of colonoscopy preparations. Your provider might recommend alternatives like polyethylene glycol (PEG), sodium phosphate, or sulfate-free preparations, which are more commonly covered by insurance policies. Make sure to talk to your doctor and insurance company to find a safe and effective alternative that is covered for you.
Does the cost of Sutab differ across different states?
Yes, the cost of medications, including Sutab, can differ based on the state and even the individual pharmacy. Prices are influenced by factors like local demand, pharmacy pricing policies, and state regulations. Utilizing tools like GoodRx and Optum Perks can help patients compare prices across pharmacies in different locations.
Does Blue Cross Blue Shield cover Sutab?
Whether or not Sutab is covered by Blue Cross Blue Shield (BCBS) depends on your insurance plan and the list of medications that BCBS covers.
If you have BCBS insurance, make sure to check your policy or reach out to your BCBS insurance representative to see if Sutab is covered by your prescription drug plan.
It’s also recommended to inquire about any prerequisites for coverage, like prior authorization or step therapy, which may be necessary before BCBS will pay for the prescription. Keep in mind that coverage can vary greatly from plan to plan and from one state to another due to differing state health insurance regulations.
Conclusion
In conclusion, navigating the landscape of prescription drug costs, especially for medications like Sutab, can appear daunting. It is essential to investigate all available avenues—from insurance and Medicare Part D coverage to alternative savings programs and discount tools. With knowledge and tools like coupons, comparison sites, and patient assistance programs, patients can get necessary medications like Sutab at a more affordable price.
Resources
- https://www.medicalnewstoday.com/articles/drugs-sutab-cost
- https://www.healthline.com/health/drugs/sutab-cost
