Ridiculous ins BS

Discussion in 'The Watercooler' started by Shari, Mar 9, 2010.

  1. Shari

    Shari IsItFridayYet?

    Back in January, I picked up my first script for Mononessa (generic ortho cyclen) of the year. Been on it 7 years for endo.

    My copay had been $10. Now its $50!

    Come to find out, thru lots of digging, the pharmacy's out of pocket price on the medication, without insurance, is $14.85. So I'm buying it without running it thru my insurance.

    Today, while looking for info for Wee's medication, I noticed the ins company's website has a prescription cost calculator, so for giggles, I pulled it up and typed in "Ortho cycle".

    Pulled it right up.

    If I purchase the name brand medication, according to their calculator, I will pay a $10 copay and the ins company will cover the remaining $45. If I buy the generic, I will pay $50 and the insurance company will pay $0.

    The numbers were similar for the mail order pharmacy!

    OMG. How crooked!

    (Meant to put this in WC ... sorry!)
  2. SRL

    SRL Active Member

    $50 copay for a $15 medication? That's quite a deal...for the insurance company/pharmacy.

    I had something similar happen right after the new year with Allergra-D, a medication my insurance has covered for over a decade at a cost of $20 to me. The pharmacist warned me that a generic became available and my coverage might be changed so I told him to go with name brand if it still covered it, and if not to do the generic. I returned and he said name brand wouldn't go through at all so he filled the generic at a cost of $70 to me. I passed at that price and went to check it out.

    After a number of calls to insurance and to another pharmacy to see what they could figure out, it turned out that if the doctor specified do not substitute, it would cover name brand at $20. If generic was specified, nothing was specified or if *I* requested name brand, it wouldn't cover it at all.
  3. Shari

    Shari IsItFridayYet?

    I don't get how this is even legal. Its crazy!

    In my case, we didn't even attempt to run the name brand, because, according to the insurance info, we're to use generic when possible for a greater cost savings (supposedly)...I see why now! The pharmacy's cost for my generic medication was $9.