Can they do this? (Rx coverage)

[marcijo]

My insurance company, Regence Blue Shield, just changed our Rx coverage. I used to pay $80 (mail order) for a 3 month supply of pulmozyme, since it is on my insurance company's formulary.
Just this past September, they changed their Rx coverage so that mail order drugs that are on their formulary, you have to pay 20% of the drug cost. So, instead of paying $80 for a 3 month supply, I now have to pay $1,035.21 for a 3 month supply of pulmozyme.
This seems SO unfair to me. Is there anything I can do? This is a medicine I need and now can't afford it. I am applying to the Genetech Endowment but doubt that I will get any help since we are ok financially, but I cannot afford $345.07 a month for just ONE of the drugs I am on.
Any ideas or suggestions for me? I am really upset that they can just do this. Changing insurances is not an option-this is my work plan so I only pay $45 a month for it (work pays the rest). If I were to be on my husbands plan, it would cost us $450 a month-which kind of defeats the purpose. I am trying to find new plans for our office (since I am in charge of the health insurance-but haven't had much luck yet).

 

[marcijo]

My insurance company, Regence Blue Shield, just changed our Rx coverage. I used to pay $80 (mail order) for a 3 month supply of pulmozyme, since it is on my insurance company's formulary.
Just this past September, they changed their Rx coverage so that mail order drugs that are on their formulary, you have to pay 20% of the drug cost. So, instead of paying $80 for a 3 month supply, I now have to pay $1,035.21 for a 3 month supply of pulmozyme.
This seems SO unfair to me. Is there anything I can do? This is a medicine I need and now can't afford it. I am applying to the Genetech Endowment but doubt that I will get any help since we are ok financially, but I cannot afford $345.07 a month for just ONE of the drugs I am on.
Any ideas or suggestions for me? I am really upset that they can just do this. Changing insurances is not an option-this is my work plan so I only pay $45 a month for it (work pays the rest). If I were to be on my husbands plan, it would cost us $450 a month-which kind of defeats the purpose. I am trying to find new plans for our office (since I am in charge of the health insurance-but haven't had much luck yet).

 

[marcijo]

My insurance company, Regence Blue Shield, just changed our Rx coverage. I used to pay $80 (mail order) for a 3 month supply of pulmozyme, since it is on my insurance company's formulary.
Just this past September, they changed their Rx coverage so that mail order drugs that are on their formulary, you have to pay 20% of the drug cost. So, instead of paying $80 for a 3 month supply, I now have to pay $1,035.21 for a 3 month supply of pulmozyme.
This seems SO unfair to me. Is there anything I can do? This is a medicine I need and now can't afford it. I am applying to the Genetech Endowment but doubt that I will get any help since we are ok financially, but I cannot afford $345.07 a month for just ONE of the drugs I am on.
Any ideas or suggestions for me? I am really upset that they can just do this. Changing insurances is not an option-this is my work plan so I only pay $45 a month for it (work pays the rest). If I were to be on my husbands plan, it would cost us $450 a month-which kind of defeats the purpose. I am trying to find new plans for our office (since I am in charge of the health insurance-but haven't had much luck yet).

 

[Alyssa]

Hey Marci... guess who..... hehehehe

Have you checked with your boss about his cost for the policy - Did Regence make this change all on their own, or did the policy that your employer purchase change.

Seems to me they cannot make changes to his current plan without changing the terms of the agreement. If you were not up for renewal I don't see how they can make a change in the middle.

Obviously someone is cutting corners here -- is your boss spending less money on the plan now after the change or is Regence making changes to your plan without your bosses consent?

You are in the unique position of being able to ask pointed questions about your plan from the employers (the paying customer of Regence) standpoint since you are your bosses representative. You should have more access in that capacity than just the "employee" (individual policy holder ) asking questions about their plan - ask your questions from the "employer/customer of Regence" standpoint.

 

[Alyssa]

Hey Marci... guess who..... hehehehe

Have you checked with your boss about his cost for the policy - Did Regence make this change all on their own, or did the policy that your employer purchase change.

Seems to me they cannot make changes to his current plan without changing the terms of the agreement. If you were not up for renewal I don't see how they can make a change in the middle.

Obviously someone is cutting corners here -- is your boss spending less money on the plan now after the change or is Regence making changes to your plan without your bosses consent?

You are in the unique position of being able to ask pointed questions about your plan from the employers (the paying customer of Regence) standpoint since you are your bosses representative. You should have more access in that capacity than just the "employee" (individual policy holder ) asking questions about their plan - ask your questions from the "employer/customer of Regence" standpoint.

 

[Alyssa]

Hey Marci... guess who..... hehehehe

Have you checked with your boss about his cost for the policy - Did Regence make this change all on their own, or did the policy that your employer purchase change.

Seems to me they cannot make changes to his current plan without changing the terms of the agreement. If you were not up for renewal I don't see how they can make a change in the middle.

Obviously someone is cutting corners here -- is your boss spending less money on the plan now after the change or is Regence making changes to your plan without your bosses consent?

You are in the unique position of being able to ask pointed questions about your plan from the employers (the paying customer of Regence) standpoint since you are your bosses representative. You should have more access in that capacity than just the "employee" (individual policy holder ) asking questions about their plan - ask your questions from the "employer/customer of Regence" standpoint.

 

[Landy]

You may be able to get some assistance from the endowment program.
I remember years ago thinking that we made too much money to get help from Genentech, but they ended up paying over $200 a month for the Pulmozyme, which made it much more affordable.

 

[Landy]

You may be able to get some assistance from the endowment program.
I remember years ago thinking that we made too much money to get help from Genentech, but they ended up paying over $200 a month for the Pulmozyme, which made it much more affordable.

 

[Landy]

You may be able to get some assistance from the endowment program.
I remember years ago thinking that we made too much money to get help from Genentech, but they ended up paying over $200 a month for the Pulmozyme, which made it much more affordable.

 

[NoExcuses]

Insurance comapnies can definitely make that change.

The reality is that the cost of "preventable" diseases is rising rapidly and unfortunately the cost is being passed on to those of us who do not have preventable diseases.

Those with cholesterol (90% of people with high cholesterol could change their condition if they would eat better and exercise), Type II diabetes (90% of these patients would get rid of their Type II if they would just lose weight), blood pressure meds (again, eat better, exercise and high blood pressure 90% of the time would go away) make up these preventable diseases. Those of us with genetic illnesses are unfortunately paying the price.

Society needs to change the way it thinks about overweight people and the affect they are having on the healthcare system. People complain of rising drug costs but rarely are educated on the reason WHY. It's tragic....

 

[NoExcuses]

Insurance comapnies can definitely make that change.

The reality is that the cost of "preventable" diseases is rising rapidly and unfortunately the cost is being passed on to those of us who do not have preventable diseases.

Those with cholesterol (90% of people with high cholesterol could change their condition if they would eat better and exercise), Type II diabetes (90% of these patients would get rid of their Type II if they would just lose weight), blood pressure meds (again, eat better, exercise and high blood pressure 90% of the time would go away) make up these preventable diseases. Those of us with genetic illnesses are unfortunately paying the price.

Society needs to change the way it thinks about overweight people and the affect they are having on the healthcare system. People complain of rising drug costs but rarely are educated on the reason WHY. It's tragic....

 

[NoExcuses]

Insurance comapnies can definitely make that change.

The reality is that the cost of "preventable" diseases is rising rapidly and unfortunately the cost is being passed on to those of us who do not have preventable diseases.

Those with cholesterol (90% of people with high cholesterol could change their condition if they would eat better and exercise), Type II diabetes (90% of these patients would get rid of their Type II if they would just lose weight), blood pressure meds (again, eat better, exercise and high blood pressure 90% of the time would go away) make up these preventable diseases. Those of us with genetic illnesses are unfortunately paying the price.

Society needs to change the way it thinks about overweight people and the affect they are having on the healthcare system. People complain of rising drug costs but rarely are educated on the reason WHY. It's tragic....

 

[2perfectboys]

90% of people with High Blood pressure and/or high cholesterol have do not have control over it, unless they take prescription meds. Both of these conditions can also be genetics, Being in the health profession, I know MANY people that are in very great shape but still suffer from one of these conditions, Genetics, genetics, genetics, and the only thing that is controlling them is meds.

 

[2perfectboys]

90% of people with High Blood pressure and/or high cholesterol have do not have control over it, unless they take prescription meds. Both of these conditions can also be genetics, Being in the health profession, I know MANY people that are in very great shape but still suffer from one of these conditions, Genetics, genetics, genetics, and the only thing that is controlling them is meds.

 

[2perfectboys]

90% of people with High Blood pressure and/or high cholesterol have do not have control over it, unless they take prescription meds. Both of these conditions can also be genetics, Being in the health profession, I know MANY people that are in very great shape but still suffer from one of these conditions, Genetics, genetics, genetics, and the only thing that is controlling them is meds.

 

[marcijo]

Hey Alyssa! <img src="i/expressions/face-icon-small-smile.gif" border="0">

Our plan was up for renewal in September and that is when they changed it. Our rates actually went up a little bit (for the same plan) - my boss didn't change anything.

Regence did send out a letter about it though-and for some reason I was thinking that this was a generic (even though I knew it wasn't) and the generic copays were going down to $20.00 for a mail order. So stupid me didn't try to order any-I waited until September...and then I got shocked with the price of what I had to pay.

I think I will go ahead and give Regence a call and get some answers....and start writing letters.

Thanks for all of the advice. And I agree-pulmozyme is a preventative medicine-why on earth would they make me pay so much that I can't afford it? It may save them alot of money in the long run. HillRom appealed their non-coverage of my vest-and we won...so I imagine I can do the same thing with this drug.

 

[marcijo]

Hey Alyssa! <img src="i/expressions/face-icon-small-smile.gif" border="0">

Our plan was up for renewal in September and that is when they changed it. Our rates actually went up a little bit (for the same plan) - my boss didn't change anything.

Regence did send out a letter about it though-and for some reason I was thinking that this was a generic (even though I knew it wasn't) and the generic copays were going down to $20.00 for a mail order. So stupid me didn't try to order any-I waited until September...and then I got shocked with the price of what I had to pay.

I think I will go ahead and give Regence a call and get some answers....and start writing letters.

Thanks for all of the advice. And I agree-pulmozyme is a preventative medicine-why on earth would they make me pay so much that I can't afford it? It may save them alot of money in the long run. HillRom appealed their non-coverage of my vest-and we won...so I imagine I can do the same thing with this drug.

 

[marcijo]

Hey Alyssa! <img src="i/expressions/face-icon-small-smile.gif" border="0">

Our plan was up for renewal in September and that is when they changed it. Our rates actually went up a little bit (for the same plan) - my boss didn't change anything.

Regence did send out a letter about it though-and for some reason I was thinking that this was a generic (even though I knew it wasn't) and the generic copays were going down to $20.00 for a mail order. So stupid me didn't try to order any-I waited until September...and then I got shocked with the price of what I had to pay.

I think I will go ahead and give Regence a call and get some answers....and start writing letters.

Thanks for all of the advice. And I agree-pulmozyme is a preventative medicine-why on earth would they make me pay so much that I can't afford it? It may save them alot of money in the long run. HillRom appealed their non-coverage of my vest-and we won...so I imagine I can do the same thing with this drug.

 

[Diane]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>2perfectboys</b></i>

90% of people with High Blood pressure and/or high cholesterol have do not have control over it, unless they take prescription meds. Both of these conditions can also be genetics, Being in the health profession, I know MANY people that are in very great shape but still suffer from one of these conditions, Genetics, genetics, genetics, and the only thing that is controlling them is meds.</end quote></div>

ding ding ding.........You are correct!
Genetics does play a large role in these conditions. Not everyone who is overweight is that way from eating too much or being lazy. High cholesterol and high blood pressure can also be caused by genetics.

 

[Diane]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>2perfectboys</b></i>

90% of people with High Blood pressure and/or high cholesterol have do not have control over it, unless they take prescription meds. Both of these conditions can also be genetics, Being in the health profession, I know MANY people that are in very great shape but still suffer from one of these conditions, Genetics, genetics, genetics, and the only thing that is controlling them is meds.</end quote></div>

ding ding ding.........You are correct!
Genetics does play a large role in these conditions. Not everyone who is overweight is that way from eating too much or being lazy. High cholesterol and high blood pressure can also be caused by genetics.