New insurance makes me pay 30% of Tier III drugs

We definitely have a idiotic healthcare system. I think when you start Remi you should be able to ditch the other meds; at least I ditched the Asacol and was fine with just the Remi.

I have to say what bugs me about our work healthcare is that all the meds for high blood pressure, cholesteral, etc are now free because there are so many in need of these meds at my company. Seems a little backwards to me. If you can control your symptoms by diet, then those folks should be charged more. Me, I have to take these meds to stay in remission. But as I discussed this with a doctor who sat next to me on a plane, she said that a stroke is more expensive than a medication and that's the way they look at it. Sorry, just venting!

If you go through BCBS mail order they give you 1 month free for 2 months of co-pays....at least that is what they did for me when I had BCBS.

I'd also call the makers of Lialda and tell them that you can't afford it, maybe they can help you with the co-pays.

Is there a Max co-pay for the year on tier-3 drugs? before you don't have to pay 30% for the rest of the year.

I currently have bcbs but Carefirst and I just have the usual copays but before I had a different form of bcbs and I had to pay a bunch too. It was cheaper and easier to do mail order and then I paid $200 for 3 months worth of Lialda which I thought was bad but it keeps me in remission so I paid it. Luckily for me I only take 2 pills per day so 3 months worth lasts 6 months unless I feel like I need to increase. You can't use the prescription assistance card on mail order either.

I hope it won't be as bad as you think it will.

Both Canada and the US have crazy healthcare costs. Prescription costs would kill me if I wasn't on my mom's plan right now.

Hopefully you might find a better deal somewhere else.

Wow, I'm amazed at the price of those drugs. Without health insurance here in Europe (i.e. full list price) the cost of Pentasa here is €150/month ($200), and the enema version is just a couple of dollars more. I don't have insurance but those who do only have a copay of €5 per medicine.

iPoop said...
the bcbs info sheet on the policy said no discount for mail order teir 3's. all the other teirs had mail order discounts. there is $2,500 cap on annual out of pocket costs for meds. sigh.

Ask your employer (or BCBS directly) if you can get an additional rider on the policy for Prescription drugs. I know that BCBS offered that to me but I didn't need it at the time because the only medicine that I was taking was Remicade.

At least there is a cap on the yearly out of pocket costs for meds, even though it may be unaffordably expensive.

They are really trying to force patients to generic drugs.

There are no generic medicines here either. The pharmacist told me that there are not enough people taking these medicines in the country for the pharmacy suppliers to bring in generics.

I'm not convinced Obamacare is going to help many. I was hoping that it would help me but I am beginning to have serious doubts. Hopefully the final numbers will be in come October 1st but right now it looks like it is not going to help me. I am currently paying $13,000 per year for a family policy with a $6000 deductible. I pay 100% of all non preventative costs of everything (including prescriptions) and after that $6000 deductible the insurance company pays 100% of all costs (including prescriptions). If my deductible was used in full my total cost would be $19000 per year, of which I can write off absolutely everything, which saves me approximately $5000 per year in federal taxes, for a final cost to me of around $14000 per year.

Right now it looks like under Obamacare my premiums would be the same $13000 but I would only pay $8500 and the government would subsidize $4500 of my premium but my out of pocket costs would be $12000 per year instead of the $6000 I have now. On top of this I'm not sure how the tax situation would work. Assuming that I could write off all of the premium I paid (the $8500), as I do now, and I could write off the maximum $7000 in medical HSA expenses, this would be a total tax savings of $4000.

Bottom line:

Now my total costs are $14000 per year - assuming I met the entire $6000 deductible for the year


Under Obamacare: $16,500 - assuming we met the out of pocket limit of $12000 per year, and this is assuming I could write off these expenses on my taxes as I do now, which I'm not so sure I will be able to

A lot of people will get very inexpensive premiums figuring in the subsidies but that does not pay the copays and other out of pocket expenses, which could be you would have to pay out of your own pockets, 20% of everything until you hit a very high out of pocket expense. The insurance itself will only be cheap if you don't use it. If you do use it your out of pocket expenses and copays could wind up being much more than you can possibly afford.

ipoop,

Can you pay into your company policy and get a better level of prescription coverage?

With my company there are several levels of coverage.