Balsalazide (Colazal and others)

How Medicare covers it

Part D (forms used at home). Part A during a covered inpatient stay. No Part B clinician-administered form in the CMS Part B spending file.

What it treats

Balsalazide treats mildly to moderately active ulcerative colitis in patients 5 years of age and older. Ulcerative colitis causes swelling and sores in the lining of the colon and rectum.

What it is for, in depth

Balsalazide is prescribed for mildly to moderately active ulcerative colitis in adults and in children 5 years and older, to calm an active flare of colon inflammation, diarrhea, rectal bleeding, and stomach pain. It fits early in the treatment path for mild to moderate disease as an aminosalicylate therapy that delivers mesalamine directly to the colon. It comes as a single 750 mg capsule strength, taken three at a time three times daily in adults for 8 weeks (up to 12 weeks in some adults in trials), with lower total dosing options described for children; safety beyond 8 weeks in children and 12 weeks in adults has not been established in the label.

How it works

Balsalazide is a prodrug that travels intact to the colon, where bacteria split it to release mesalamine (5-ASA), the active part. Mesalamine appears to calm inflammation locally on the colon lining, though its exact mechanism is not fully understood.

How it is taken

Adults take 2.25 g — three 750 mg capsules — three times a day for 8 weeks, with or without food, swallowing capsules whole. People who cannot swallow capsules may open them and sprinkle the contents on applesauce to chew and swallow right away, and everyone should drink plenty of fluids.

Common side effects

The label extract does not list a separate common side-effects list with percentages; it focuses on clinically significant reactions described in the warnings. Do not invent other common effects from this label — ask your pharmacist for the full patient information if you need the complete list.

Serious warnings

It can harm the kidneys, including kidney failure, and can cause a mesalamine acute intolerance syndrome that looks like a colitis flare. Serious allergic reactions including heart inflammation (myocarditis and pericarditis), liver failure, severe skin reactions, and kidney stones have also been warned about.

Who should be careful

People with kidney problems, liver impairment, pyloric stenosis or other stomach outlet blockage, or allergy to salicylates or aminosalicylates need caution or should not take it. Older adults have a higher risk of blood problems, and people with skin conditions should protect themselves from the sun because of photosensitivity.

Major interactions

Kidney-toxic drugs, including NSAIDs, raise the risk of kidney harm, so kidney function should be monitored. Taking it with azathioprine or 6-mercaptopurine raises the risk of blood disorders, so blood counts should be monitored.

Cost and saving notes

Generic balsalazide capsules are available, which are often less costly than the brand. If your Part D plan places this drug on a higher tier, you can ask the plan for a tier exception, and Extra Help (the Low-Income Subsidy) can lower Part D costs if you qualify; the annual Part D out-of-pocket cap also limits total drug spending for the year.

Why it is in its tier

Balsalazide (Colazal and others) sits on Tier 4 in 75.43% of the plans that list it (4145 of 5495 listing plans). Tier 4 is the non-preferred tier — higher copays or coinsurance. The data-visible drivers: It is a generic product, and the CMS dashboard puts its average Part D spending at about $781 per beneficiary for 2024 — a relatively low-cost drug, which matches where plans place it. It is listed by 100.0% of Part D plans. The tier shown is the most common one; individual plans vary.

Sources

• BALSALAZIDE DISODIUM CAPSULE [PD-RX PHARMACEUTICALS, INC.] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus

What official patient guides say

Take the capsules three times a day with or without food for usually 8 weeks (sometimes up to 12 weeks), and keep taking them even if you feel well. If you cannot swallow capsules whole, you may open them and sprinkle the contents over about 2 teaspoons of applesauce and eat it right away, knowing it may stain teeth and tongue, and drink plenty of fluids throughout treatment. If you miss a dose, take it when you remember unless it is almost time for the next dose, and store the capsules at room temperature away from heat and moisture.

Source: MedlinePlus

Part D formulary coverage

Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.

What you pay

Without insurance, the cash benchmark is 0.32049 per unit (BALSALAZIDE DISODIUM 750 MG CP) — about nan for 30 units. NADAC benchmark — the average price pharmacies pay (CMS, as of 2026-11-04). Pharmacy shelf prices vary.

A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.

Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-07

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 5,495 list Balsalazide (Colazal and others) — 100% of plans. Most of those plans put it on Tier 4: 4,145 plans, 75.4% of the plans that list it. Other plans place it on Tier 2 (567 plans), Tier 3 (418 plans) or Tier 1 (365 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 4; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 4; Aetna Medicare Value Plus (PPO) puts it on Tier 4. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan';s deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30

Companies covering this drug

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.