HealingWell
Search Close Search
☰

BCBS new "Medicare" pharmacy choice

Support Forums
>
Ulcerative Colitis
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 10/12/2023 4:38 PM (GMT 0)
Anyone on here see where BCBS has new pharmacy benefits based off Medicare?

The site indicated (at the beginning) that it's an additional benefit but if you start to read it's an "opt in or opt out" and you have to wait for the following year to change.

I called in to BCBS and they didn't have a lot of information. They'll have more closer to enrollment. I also made some calls to medication assistance programs that assist individuals that have Medicare BUT those individuals must have pharmacy insurance thru their secondary insurance. The person stated that if you have a Medicare affiliated pharmacy even thru secondary insurance the assistance programs would not be able to help you.

So I am trying to be very careful here... Anyone else see or hear about this?

Clo
Posted 10/12/2023 5:53 PM (GMT 0)
Clo, I haven't seen or heard anything yet. You may want to go into the Texas BCBS website & see what you can find there. Each state is different.

I am thinking October 15 is when the new rates will come out.
Posted 10/13/2023 2:35 AM (GMT 0)
Yes new rates should be out about then.

I'm trying to understand this insurance before I hit social security/medicare age. One of the ladies in my support group is concerned. Her Remicade stopped working and she plans to utilize the patient assistance programs some of the drug companies have... but the assistance does not help individuals that have insurance... including prescription... thru Medicare based contracts. The new BCBS pharmacy insurance is such a program so my friends drug cost will go up if she does not opt out of the Medicare/BCBS pharmacy program. She would go from a 5.00 monthly charge to a maximum of approximately 3200+ if the Medicare/BCBS covers the medication. Formulary was not available yet ... Anyway I think that's the way it works.

I spent today in the phone with insurance, doctors and assistance programs trying to get a grasp on this... Plus my spouse has been having health issues so I feel slammed. I'm juggling so many balls in the air I am afraid I'm going to drop one .... So I am hoping there are others on here that see this and indicate where I may need to look closer.

I'll check out that website too.

Clo
Posted 10/13/2023 3:52 PM (GMT 0)
Clo — what I’ve been told is that its medicares non-negotiation clause which keeps Medicare users from using the assistance programs. The non-negotiation clause does help recipients so I think it’s a double edged sword.

Anyway, the way I work it is this: the drug companies actually have 2 different assistance programs. One is the easy to find advertised assistance program. Most — but not all — also have another program where they will give you the medication for free after you submit a yearly application. They want to know your yearly income and then they check with your insurance to make sure their medication is not affordable for you. It’s kind of a hassle each year but worth it in the end. But it also requires a lot of investigation especially is you’re thinking of a medication change and which companies offer the free assistance. They all term their programs different names but they are not the copay assistance. I always call the copay assistance line and ask if they have a free program for those that don’t qualify for the copay plan. I get my migraine injection through there and have also in the past gotten my Apriso and uceris for free.
✚ New Topic ✚ Reply