health insurance

[audreyh1]

Quote:

Originally Posted by ducky911 Well ! I was one of the lucky ones to have my health insurance canceled and replaced with one that's about 400 dollars more a month....great Now we find out that two of the meds that my wife is on are now not on "the list". Called the doctors office and they have been getting 100 calls a day from people wanting to change to another med....whatnext?

You can still change plans. Open enrollment is until March.

[ERhoosier]

Quote:

Originally Posted by Sue J My son is 29 and has his own insurance through his work. He's been on Advair Diskus for asthma since it first came out many years ago. This year's prescription plan puts that medication in it's 3rd tier and he would have to go through their managed step process again and then pay a very expensive price to stay with Advair. Instead his Dr switched him to another medication and gave him a 30 day sample to try. I hope he can tolerate the change, the Advair worked really well for him.

Truly hope your son does well with the med change.
Generally, I view this too-common HI plan practice as foolish. How much $$$ is lost to extra doc & hospital care when folks deteriorate after being forced off their stable meds?

[ziggy29]

Quote:

Originally Posted by ERhoosier Generally, I view this too-common HI plan practice as foolish. How much $$$ is lost to extra doc & hospital care when folks deteriorate after being forced off their stable meds?

In terms of cost control I can understand it. The problem is that sometimes this "step therapy" approach doesn't work, and when it doesn't it can be a LOT more costly than staying on the "tier 3" medications to begin with -- not to mention inflicting a lot of unnecessary suffering and problems.

Think about how much more expensive things would be if no one ever paid more out of pocket for brand name drugs than for generics. This is the same concept to a large degree, except that the active ingredients aren't necessarily identical.

[ducky911]

Quote:

Originally Posted by audreyh1 You can still change plans. Open enrollment is until March.

Well thanks for all the info. Here is an update. Athem will cover rx off the list if the doctor fills out a form saying you have to be on that med.

To get info you have to call anthem and be on hold for as low as 30 min and more likely 90 min....to figure this out it has taken 5 phone calls....not happy with them.

I may look to change down the road. The funny thing is I have the bronze plan so basically I am paying for most everything out of pocket..but if the insurance covers the med it is at the discounted price but if it is not the the list pharmacy demands full retail.

So question...Why do pharmacies have these retail prices now that everyone has insurance? I think that it should be one price for everyone.

[Buckeye]

Quote:

Originally Posted by ducky911 So question...Why do pharmacies have these retail prices now that everyone has insurance? I think that it should be one price for everyone.

Why did they (doctors, hospitals, pharmacies, etc) EVER have a two-tiered system that basically screws the uninsured who typically can least afford it! For the last 5 years, the main purpose of our very high deductible policy has been to keep from paying rack rate. Frustrating beyond description!

[Gotadimple]

Quote:

Originally Posted by Accidental Retiree DH also checks with Target and Costco before he fills prescriptions.

Target prescription costs show up on GoodRx.com. Not sure that Costco does.

- Rita

[ERhoosier]

Quote:

Originally Posted by ziggy29 In terms of cost control I can understand it. The problem is that sometimes this "step therapy" approach doesn't work, and when it doesn't it can be a LOT more costly than staying on the "tier 3" medications to begin with -- not to mention inflicting a lot of unnecessary suffering and problems. Think about how much more expensive things would be if no one ever paid more out of pocket for brand name drugs than for generics. This is the same concept to a large degree, except that the active ingredients aren't necessarily identical.

I'm not anti-generics or anti-copays, and I fully understand need to control HC costs & logic behind so-called "step" therapy. However- more than once I've seen family/friends switched off their "costly" medication only to rack up much more HC costs (extra labs, doc visits, even hospitalization) than what was "saved" by enforced switching of stable meds. IMHO- HI co bean-counters can focus sooo much on drug cost per se that they loose sight that real goal is containing overall HC costs.

Clearly some drugs are $$$$$$ for minimal benefit over older generic alternatives, but I've seen some "tier 3" drugs (mostly older branded version of now off-patent drug) which were not that expensive on open market. In few cases the HI's tier 3 co-pay ($39-50+) has been MORE than "no-insurance" cost at discount pharmacy (e.g. WalMart).
It pays to shop around sometimes.

[Sue J]

Quote:

Originally Posted by Gotadimple Target prescription costs show up on GoodRx.com. Not sure that Costco does. - Rita

Costco has their own price checking feature on their pharmacy page.
Costco Drug Information

You do not have to be a Costco member to use their mail order pharmacy. You make an online account and submit your Rx info and then mail in your paper Rx. They match it up to your online info and process the Rx. They may have feature to have your Dr. fax in a RX. I had a paper one already so I went that route.

They did not take my insurance but the cost savings were significant for me vs Express Scripts through my insurance. The costs won't be applied to my deductible but it's still worth it.

My Rxs were
Losartan 25mg x 90 = Express Scripts $32 or Costco $10
Pravastatin 10mg x 90 = Express Scripts $46 or Costco $14

Pravastatin was always a cheap generic ($10 or under for 90 days) on most Rx sites and just recently the price jumped up to the $45 range. I asked about this and it's because it's an older generic and some manufacturers have stopped making it and are making other, newer types. So now there is a shortage of pravastatin and they can increase the price.

My pravastatin order at Costco was supposed to be close to $50 but since the online price was $10 when I ordered it they honored the lower price for this refill and told me to check again before I refill.

At refill time I'll check on GoodRx for a coupon.

[Mulligan]

Quote:

Originally Posted by Sue J Costco has their own price checking feature on their pharmacy page. Costco Drug Information You do not have to be a Costco member to use their mail order pharmacy. You make an online account and submit your Rx info and then mail in your paper Rx. They match it up to your online info and process the Rx. They may have feature to have your Dr. fax in a RX. I had a paper one already so I went that route. They did not take my insurance but the cost savings were significant for me vs Express Scripts through my insurance. The costs won't be applied to my deductible but it's still worth it. My Rxs were Losartan 25mg x 90 = Express Scripts $32 or Costco $10 Pravastatin 10mg x 90 = Express Scripts $46 or Costco $14 Pravastatin was always a cheap generic ($10 or under for 90 days) on most Rx sites and just recently the price jumped up to the $45 range. I asked about this and it's because it's an older generic and some manufacturers have stopped making it and are making other, newer types. So now there is a shortage of pravastatin and they can increase the price. My pravastatin order at Costco was supposed to be close to $50 but since the online price was $10 when I ordered it they honored the lower price for this refill and told me to check again before I refill. At refill time I'll check on GoodRx for a coupon.

Not on any meds, but I poked around on a few on Costco link...$900 for 30 pills of Viagra.. WTH? Having sex will apparently not be one of my old age hobbies if I need any assistance. You got to be kidding me. I thought it was like $10 a pill. I can see it now in the old yearly retirement spreadsheet: Food $5,000, Viagra expense $10,800.

[ziggy29]

Quote:

Originally Posted by Mulligan Not on any meds, but I poked around on a few on Costco link...$900 for 30 pills of Viagra.. WTH? Having sex will apparently not be one of my old age hobbies if I need any assistance.

Viagra should "go generic" in the US in 2019. I think it already recently went generic in Europe.

[Mulligan]

Quote:

Originally Posted by ziggy29 Viagra should "go generic" in the US in 2019. I think it already recently went generic in Europe.

Well if I don't, and I need it, I will have to institute corporate America cost cutting measures... Subcontract the work out at nonunion wages.

[haha]

Quote:

Originally Posted by Peter I suspect this is a bit tongue in cheek, but just to set the record straight, the base rate is 20% for taxable incomes up to £32,010. And there is a personal allowance of £9,440 at the zero tax bracket. 50% tax rate does not kick in until taxable income gets above £150,000. By the time you factor in Federal, State, sales, and property taxes, US taxation is very similar to that in the UK. Sorry for the slight hijack.

True, but our taxes go for valuable things like world domination.

[haha]

Quote:

Originally Posted by Mulligan Not on any meds, but I poked around on a few on Costco link...$900 for 30 pills of Viagra.. WTH? Having sex will apparently not be one of my old age hobbies if I need any assistance. You got to be kidding me. I thought it was like $10 a pill. I can see it now in the old yearly retirement spreadsheet: Food $5,000, Viagra expense $10,800.

At least you'll have to cut down on your daily indulgence. Mother nature seems to already have cut me back a bit.

Ha

[Mulligan]

Quote:

Originally Posted by haha At least you'll have to cut down on your daily indulgence. Mother nature seems to already have cut me back a bit. Ha

Well at $30 a pop, you can just cut mine off. That is just outrageous. I am not back checking this, going off my memory but I know that thing sold for $10 or less when it came out. Then it was supposed to come off patent a few years ago, then they regigered the formula as a scam to extend the patent which if Ziggy is correct til 2019. They are just legal bandits extracting profits until it goes generic, then watch it sell for $2 a pill.

[M Paquette]

For folks on Kaiser Permanente via the Covered California (Coveredca.com) exchange, Kaiser's internal online payment system is starting to come to life.

Earlier this month, trying to see bills or make payments was a great way to see error screens or a blank, vast nothingness...

As of Tuesday one could see the new bills, but payment attempts led to one of those annoying 'placeholder' pages.

Today things are much better.

The bills are visible, and the 'one time payment' option is hooked up, taking credit cards, and returning confirmation numbers. (The autopay monthly payment system accepts information but reports 'failed to process transaction' and drops me back to the start.)

Even better, the bill/payments made display shows all persons covered, so it's very reassuring to see all the family members there.

Best of all, the February payments, usually due by the first of the month, show that they are due on February 17. It looks like they actually realize that they've been having problems and are giving customers an automatic extension.

They've had to revamp their whole payment system for individual insurance policies to handle the CoveredCa.com connection and the tax credit advance payments. I suspect the past few months has not been a happy fun time for the IT folks there.

[Brat]

"You do not have to be a Costco member to use their mail order pharmacy. You make an online account and submit your Rx info and then mail in your paper Rx. They match it up to your online info and process the Rx. They may have feature to have your Dr. fax in a RX. I had a paper one already so I went that route.

They did not take my insurance but the cost savings were significant for me vs Express Scripts through my insurance. The costs won't be applied to my deductible but it's still worth it."

Really!!! I just ordered refills through Express Scripts and found that their prices increased. I will check Costco's prices and if there is a saving transfer my prescription.

[Accidental Retiree]

Prices are lower, though, if you are a member. DH just checked Costco prices against Target's, and Costco won by a small bit.

Target said the one place they cannot price match is Costco.

Also, if you have a Costco nearby, you can walk in and get a price check pretty easily. Sometimes they have the meds lower in store stock than online, too.

[45th Birthday]

Quote:

Originally Posted by Sue J My son is 29 and has his own insurance through his work. He's been on Advair Diskus for asthma since it first came out many years ago. This year's prescription plan puts that medication in it's 3rd tier and he would have to go through their managed step process again and then pay a very expensive price to stay with Advair. Instead his Dr switched him to another medication and gave him a 30 day sample to try. I hope he can tolerate the change, the Advair worked really well for him.

We are on a HDHP, and son is also on Advair. It would cost $230+ per month to get it through the plan. Solution: CanadaDrugsOnline.com for $60 per month. Same drug, made elsewhere.

[sengsational]

Quote:

Originally Posted by Mulligan Not on any meds, but I poked around on a few on Costco link...$900 for 30 pills of Viagra.. WTH? Having sex will apparently not be one of my old age hobbies if I need any assistance. You got to be kidding me. I thought it was like $10 a pill. I can see it now in the old yearly retirement spreadsheet: Food $5,000, Viagra expense $10,800.

Just book a trip outside the U.S. and schedule in a doctor visit. Or in some places, just walk into a pharmacy.

[aja8888]

Quote:

Originally Posted by Mulligan Well at $30 a pop, you can just cut mine off. That is just outrageous.

Plus, you have to buy dinner and drinks along with that!