Prescription medication SUTAB, a combination of potassium chloride, magnesium sulfate, and sodium sulfate, is used to empty the colon before procedures such as colonoscopies. Patients who find it difficult to pay for colonoscopy prep often choose it because it is thought to be less expensive than other bowel prep kits. But many insurance plans still won’t cover it, despite the fact that it’s less expensive. Patients are left wondering why SUTAB isn’t covered by insurance.
High Costs of Colonoscopy Preparation Medications
Nowadays, getting a colonoscopy to check for colon cancer and other colon problems is pretty standard. The worst part, though, is that the preparation work can be extremely taxing on your finances and physical health. You see, the traditional prep kits force you to stick to a clear liquid diet while downing copious amounts of liquid laxatives for hours on end. Even with insurance, it can cost more than $100 and cause discomfort and hassle.
Here’s SUTAB, a more chilled prep option that was FDA-approved back in 2020. It only takes about 16 ounces of diluted medication, divided into two doses, to be consumed. It’s much simpler to manage. In addition, a box of it costs only roughly $35 without insurance. Though still not cheap, these kits are unquestionably more feasible for many people than the traditional ones.
The catch is that the cost of colonoscopy preparation medications can vary greatly. Some high-end, name-brand items can cost more than $200. Depending on your plan, you could be looking at paying anywhere from $20 to over $100 for insurance. It can be difficult to decide between something like SUTAB, which is less expensive but uninsured.
Insurance Utilization Management Policies
Why, then, is SUTAB not covered by insurance? It all comes down to the way insurance companies do business. These utilization management procedures are in place. To put it simply, they employ physicians and pharmacists to sort through medical records and determine which medications to cover. However, in the case of SUTAB, insurance may argue that “Hey, there’s not enough proof that it’s better than the older stuff that already has generic versions.”
See, since generic medications are less expensive, insurance companies like to promote them. Additionally, no generic options are available yet because SUTAB is still relatively new. The kits for colon prep that contained polyethylene glycol in the past? Indeed, generics are available, which translates to cheaper costs. Those older options might still be less expensive with insurance.
Furthermore, some people in the insurance industry haven’t given SUTAB much thought or see it more as a luxury than a necessity. They might continue to refuse to cover it until there is conclusive evidence or generics are introduced to the market.
Lack of FDA-Approved Indication
For adults, SUTAB is currently approved by the FDA to prepare the intestines before a colonoscopy. However, there are many other bowel prep medications available with additional approvals that may facilitate their insurance coverage.
For example, a few of these options are also approved for preparing your intestines prior to colon surgery or CT scans. Unlike SUTAB, which isn’t available to anyone under the age of 18, they might even be beneficial for children. Insurance companies view a product as more medically versatile if it has more FDA nods.
The worst part is that there isn’t yet a ton of reliable research contrasting SUTAB with these other preps. Further research demonstrating that it is on par with or superior to the ones that insurance currently covers could lead to additional options for coverage in the future.
Patient Assistance Options
Now, here’s the thing: for some people, the expense of obtaining SUTAB through insurance can be a major obstacle. Hey, don’t worry too much about it; there are ways to get financial assistance. Check it out: if you have commercial insurance, the folks at Salix Pharmaceuticals, the company that makes SUTAB, have this great savings card that can help reduce the amount you have to pay out of pocket. Salix has this program where you might be eligible for free SUTAB based on your income if you’re uninsured or your insurance doesn’t cover much.
In addition, hospitals and endoscopy centers may offer financial assistance of their own for procedures performed there. You could find out if they have any ongoing assistance programs or if they have any extra SUTAB samples lying around. Additionally, remember to discuss it with your healthcare provider as well; they may be able to assist you with samples or coupons.
And hey, there may be clinics nearby that can help you find reasonably priced prep options if you live in a lower-class neighborhood.
And here’s a tip: if you meet their requirements, you may be eligible to receive financial assistance for your colonoscopy from certain non-profit organizations. Consider the Patient Advocate Foundation Copay Relief Program, which assists with the copays for drugs such as SUTAB. And what do you know? SUTAB may not be covered by Medicare or some insurance plans, but for those who qualify, some state Medicaid programs do. So, it’s something to consider!
Providing Medical Necessity Documentation
Now, in the event that your insurance provider turns you down and refuses to cover SUTAB, you shouldn’t give up just yet. There are choices available to you. One way to respond is to challenge their ruling. Sometimes, all you need is a letter from your doctor outlining your specific need for SUTAB, along with some good documentation.
Why would they suddenly make an exception? They might, however, bend the rules for you if you’ve had negative reactions to other preps they cover or if you have health concerns that prevent you from taking the typical big-volume preps. Any documentation demonstrating prior problems with other preps or explanations for why SUTAB is the best option for you should be gathered up.
While going through the entire appeal process will undoubtedly take some time and effort, it is still worthwhile. Ultimately, they may just come around and cover it if they see that SUTAB is truly important for your health. Therefore, fight for what you need, and don’t give up!
Considering Over-the-Counter Alternatives
Currently, SUTAB is only available by prescription, limiting over-the-counter alternatives. However, there are some options patients could consider discussing with their doctor if needing a more affordable preparation option.
Several over-the-counter laxatives, stool softeners, enemas, and oral sodium phosphate products are FDA-approved for general cleansing and could potentially be used off-label for colonoscopy preparation. Combining Miralax with prescription medications like magnesium citrate is one regimen sometimes used. Off-label does not mean unsafe, and many of these products have been used for decades.
Of course, discussion with the ordering physician is imperative before taking matters into one’s own hands. Experts know acceptable alternatives and best practices that balance safety, effectiveness, and affordability. Clear communication and shared decision-making around bowel preparations lead to the best outcomes.
Advocating for Policy Changes
On a broader scale, patient advocacy has the potential to lead to positive changes in SUTAB insurance coverage policies. Individuals sharing their experiences through legislative advocacy, writing campaigns, and social media can increase awareness and drive change.
Advocacy groups like Fight Colorectal Cancer focus efforts on equitable screening access. The Colon Cancer Coalition’s Bowel Movement aims to remove financial barriers to colonoscopy. Individual stories and group activism give these organizations the power to lobby for affordable colonoscopy preparations for all.
While major policy changes are not immediate, public pressure and legislative action can eventually lead insurance companies to re-evaluate their coverage decisions. Advocacy and education on the barriers to screening access remain important.
Conclusion
To put it another way, the FDA hasn’t approved newer bowel prep options like SUTAB for everything. They’re more expensive, and there isn’t a ton of research comparing them, so insurance companies often won’t cover them. However, there are workarounds for it! You can use over-the-counter medications in their place, apply for financial aid, make the case that you truly need it for your health, or even take an active role in advocating for change.
In summary, even if your insurance company doesn’t support the best preventative measures, you can still afford colon cancer screening if you’re creative and determined.
