Our prescription coverage changed and we are TOAST...

Discussion in 'The Watercooler' started by gcvmom, May 7, 2009.

  1. gcvmom

    gcvmom Here we go again!


    I knew that things had changed in our prescription plan, but I had no idea things were going to get so ugly.

    I just went online to reorder some mail order medications... difficult child 2's Seroquel XR (which is covered by the plan, but since it's a brand name and there are no generics, we have a higher copay) is now $150 for three months, versus the $45 it was last year for the same amount (and he takes 400's and 300's, so that's two rx's). Okay, that's a big jump. But that's not the one I'm freaking over...

    difficult child 1 takes Imuran for his Crohn's disease. His GI wants him on the brand drug and not the generic because in her experience (and she is a leading researcher in the field) the brand name drug is metabolized better. And since it's THE drug that put difficult child 1 in remission and allowed him to finally GROW (in 5th grade, he was the size of a 1st grader), I was only too happy to follow her orders.

    But this drug is NOT covered by the formulary. Period. So now the same drug that cost me $70 for 90 days last year now costs...



    That's more than a 900% increase.

    I just got word, though, that my brother in law#3 got hired last week as the regional director for Blue Cross... which happens to be our insurer. I don't know if he can do anything about this, but I sure as heck am going to ask.

    I worry about what might happen if we switch difficult child 1 to the generic drug and his disease flares up. That's the LAST thing he needs right now. But I sure cannot afford to pay $2,900 a year for ONE drug for ONE person.

    I need to call around and get retail pricing from Walmart, Costco, etc. before I totally flip out...​
  2. witzend

    witzend Well-Known Member

    OMG, who supplies the insurance? When I was younger and the kids were in school, I worked for the local large retail grocery chain. It was a union store. There were (and still are) a lot of people who work the minimum 80 hours a month, which is fairly easily done during school hours, to be covered by the insurance plan. They bargain collectively, so they get excellent benefits.

    I would also look into the club card membership at Walgreens. They have a program that issues a membership card for $20 that gives at least 1/2 price off on most name brand prescriptions. Costco is a good bet if you already belong. I have the business membership, which gives me money back for every dollar I spend. The membership is $100, but I get a check every year for at least $130 so I come out ahead.

    Talk to your doctor about programs from the drug manufacturers and any samples he can help with. It's outrageous...
  3. gcvmom

    gcvmom Here we go again!

    Medco is our prescription plan, which is a subsidiary of Blue Cross, which is our health insurer (the policy is through husband's employer... a large financial firm) -- we pay extra for the danged PPO plan, which I THOUGHT meant we had better coverage. That's why I'm hoping to get help from brother in law, but then he's going to be so new that he won't yet have the clout needed to do much about this yet.
  4. SRL

    SRL Active Member

    I'd call your doctor and see if there's anything s/he can do. I know letters can sometimes get a specialist covered so maybe one could also get a medication covered. If she's the leading researcher in the field maybe she'll have the clout to get the job done.
  5. goldenguru

    goldenguru Active Member

    And people don't think our health care system needs to be revamped? Good grief!!
  6. Lothlorien

    Lothlorien Active Member Staff Member

    You may even try calling the drug company. They have plans to help out with the costs of drugs.
  7. tiredmommy

    tiredmommy Site Moderator

    We have UnitedHealthCare and Medco; we decided to go with the high deductible plan and an aggressive HSA account because husband's employer will deposit into the HSA. We pay up front now but get 90% coverage once the deductible is met. Plus we can pay for services or medical supplies from the HSA. We're saving around $1000.00 a year by doing it this way. You might consider looking into that option when open enrollment comes around in the fall.
  8. slsh

    slsh member since 1999

    GVC, another thought would be to contact the HR dept at husband's company. If his company is self-insured and BC/Medco just administer the benefits, his employer might be able to help out a lot. Even if they're not self-insured, they are the customer and may drive what is and isn't covered. We've cut through a lot of insurance co. bologna by going thru my husband's company to deal with coverage issues.
  9. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    My brother has Crohn's. A terrible disease. You have my prayers and I hope you get good answers.
  10. hearts and roses

    hearts and roses Mind Reader

    Ugh, we have Medco also - through United Healthcare/Oxford and I hate it. We also pay the higher premium for better cover and supposed cost breaks. Bah! All the medications easy child/difficult child/I take on a regular basis are considered "preferred", which means we have to pay top dollar. Believe it or not, the worst is when I utilize the mail in form of getting our RX. A while back I was taking Wellbutrin XL and the Dr checked off the "Dispense as Written" box and they still sent me the generic. Well, it made me CRAZY and when I called they passed me from manager to manager and I got nowhere. They all said it wasn't generic, but it was written clearly on the bottle as a generic. I had to go get another script and take it to my local pharmacy, which ended up costing me an extra $15/month. Argh. Hate Medco, but for us it's better than nothing.

    I hope you're able to resolve this. I wouldn't count on your brother in law being able to do anything major. Any chance you could switch coverage?
  11. Nancy

    Nancy Well-Known Member Staff Member

    We had the same problem with Lamictal when our coverage changed. The drug went from $150 for three months to over $900 for one month. We were very lucky because just that month it came out in generic but we would have had to look for alternative if it hadn't.

    This is a horrible problem for anyone that has to take a particular drug. I don't understand how a drug company thinks anyone can afford those prices.

  12. AnnieO

    AnnieO Shooting from the Hip

    I guess I am really lucky here. Right now all the kids' prescriptions are covered at 100% since BM has them on Medicaid. I do remember getting Concerta at one point when she had cancelled their insurance, before pediatrician had us wean difficult child 2 off. $540. And of course BM refused to pay her share.

    I was a little worried last week when I took my scrip for Lexapro in. I have BCBS as well, and pay a percentage, so I wasn't sure. Waited more than an hour for the pharmacist but then when I whipped out the check card... The balance was $0. Not sure how that works but I'd bet it's cause I went to Walgreens. They have all kinds of neat stuff like that.
  13. KTMom91

    KTMom91 Well-Known Member

    If you're an AAA member, they offer prescription discounts. That's the only thing that helped us during the six months none of us had coverage. Not all pharmacies will accept the discount, Walgreens didn't, but I think Costco does. It's worth a try!
  14. Star*

    Star* call 911........call 911

    Find out who manufactures each drug -
    Find out what kind of help/pay program they have.
    Don't take them at their word that if you have insurance they won't help. Some, like Phizer will do a hardship prescriptions even IF you are under insurance because it's a specialty drug. I can't say about being under the poverty guidelines - but I qualify for that. WAY under.

    Another thing is that since this dr. is the leading researcher - she should be able to set you up with freebies since she is more than likely using your difficult child for a test subject in a trial. (my guess)

    Maybe - too - (I'm A BCBS Group Benefit Admin in our office) you can have your GBA call your ins. agent and ask what it would cost outof pocket for you to change your prescription drug coverage on an individual basis.

    Hugs - i know this hoovers.
  15. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Even if its not in the formulary, you can fight the formulary if this is a change and the person has been on the medication for awhile. Also they should cover it for at least three months while this is going on to give the dr time to come up with a new medication that IS on the formulary.

    This should all be written in the new formulary that was sent to you.

    I get a new formulary sent to me every January and cringe.
  16. gcvmom

    gcvmom Here we go again!

    Well, they did give us notice at the end of last year that their formulary was changing and certain medications would be affected ... I just didn't think to look into it any further to find out if any of ours were now off the list. And when I reordered difficult child 1's Imuran in January, the mail order pharmacy made a mistake and only charged us $30 for three months, so I just assumed that was the new price.

    The drug is available as generic -- it's just not what the doctor wants him to take. I'm going to call the office now and let them know what's happened. Perhaps they can send a letter... But in the mean time he's only got a week or so left, so I need to get this resolved NOW.
  17. totoro

    totoro Mom? What's a GFG?

    I am so sorry.
    Insurance companies hoover. It is always scary each time you get any mail from them.

    I am sorry. You need a huge break.

    We have been lucky so far with United Health Care.
  18. nvts

    nvts Active Member

    GVC! NYS just announced a program that will help with prescriptions. While I know you're not in NYS, take a look at the site and then google it for your state. A lot of the times they put these programs out there and are very tight lipped about availability.


    I'd also check with the drug companies and also google Montel Williams. He was the spokesman for a group (non-profit) that was helping people in exactly your situation.

  19. susiestar

    susiestar Roll With It

    I am sorry. This happens to us every year. husband's company will NOT give us info on what the new coverage is when we reenroll in plans, at least not as far as what the copays will be. So every freakin' year I get a jolt when I have to get rx's in Jan.

    It just stinks. Each year they have gone up a LOT. Right now we are actually FORCED to us the mail in (owned by the insurance co) for ALL maintenance medications. And I just sent a new script in from the new doctor for my pain medications. BUT they want a new one because they said it was too soon. So now, 2 DAYS after the rx expired they will accept a new script. It will cost me $30 to have the doctor write the new script, and problem 3 weeks to get the medication, even with rush delivery.

    And at almost triple the cost of the same medication as last year.
  20. Kjs

    Kjs Guest

    Well Blue Cross is my insurance too. I didn't get any notice on a change. Are we suppose to?

    However, I work for pharmacutical company, and one of their benefits is that any drug they make is free. Must be brand name.

    unfortunately - most drugs we have are not Abbott drugs.

    Biaxin and a couple antibiotics. They don't make much in the way of antidepressants. I don't think they make any.

    But they do make Humira, which is for Chron's disease. And they also make Depakote. Too bad difficult child isn't on that. They do make Vicoden, which is what husband takes for his back. Hope they start making more in the line of anti depressant's.