Insurance changes for high price medications like Humira

Many medical insurance plans have open enrollment periods in July through December. It is very important for everyone taking medications like Humira, Remicade, or other expensive drugs to carefully check the policy options they are being offerred. As many already know, all policies are not created equal. Recent news stories have outlined how insurance companies are instituting a Tier 4 for expensive medications.

This new tier is being modeled after ones instituted by Medicare drug plans. Instead of fixed formulary charges like $10, $20, and $30 dollars for 1,2, and 3 tier medications, the 4th tier charges patients a percentage of the drug's cost. The NY Times article cites this percentage as anywhere from 20 to 33% of the medications cost. This change could make certain meds unaffordable.

Also, anyone that has Tricare - be advised that Enbrel and Kineret are being moved to Tier 3 as of June 18, 2008. As I see it, this means Humira is likely to follow suit in the near future. Make absolutely sure that you order your Humira by mail or from a Tricare Network Pharmacy. Tier 2 drugs [Humira] ordered from a NON-Network Retail Pharmacy will cost 20% of the ACTUAL cost for a 30 day supply.

Very good important advice. Thanks so much for sharing. My husband is changing jobs and so insurance and this came at a great time. Thanks again, everyone here does such a great job! You are appreciated!