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Pulmozyme Question

M

marcijo

Guest
I take pulmozyme and have been on it for about 6 months now. I went to re-order more via mail order and found out my insurance changed the way prescriptions are paid for. I was paying $80 for a 3 month supply. Now they have changed it (it is still on their formulary, but it is brand name) and I have to pay $345.07 per month! And it is even more expensive to get it at a retail pharmacy (like your local drugstore). Getting it mail order is 20% ($345.07) and getting it retail is 30% ($488.00)!

Can they just change it like this? We cannot afford a $345.07 med payment-and that is just one of the meds I am on! For the vest I am going to have to pay $250 per month for about 16 months (plus meet my deductible of $750 per year). We make pretty good money but there is no way we can afford this.

Any ideas for me?? I am applying to the Genetech Endowment for Pulmozyme, but I highly doubt we will get that big of a break because of our income (which is not high....my husband is a teacher and I work 30 hours from home....but high enough that I don't think we will qualify for anything).

I just don't think its fair at all that they can change what I pay from $80 for a 3 month supply to $345.07 per month! That is a HUGE increase! I plan on writing a letter to the insurance company and to the makers of Pulmozyme, but I highly doubt it will make a difference.

Thanks for your help.
 
M

marcijo

Guest
I take pulmozyme and have been on it for about 6 months now. I went to re-order more via mail order and found out my insurance changed the way prescriptions are paid for. I was paying $80 for a 3 month supply. Now they have changed it (it is still on their formulary, but it is brand name) and I have to pay $345.07 per month! And it is even more expensive to get it at a retail pharmacy (like your local drugstore). Getting it mail order is 20% ($345.07) and getting it retail is 30% ($488.00)!

Can they just change it like this? We cannot afford a $345.07 med payment-and that is just one of the meds I am on! For the vest I am going to have to pay $250 per month for about 16 months (plus meet my deductible of $750 per year). We make pretty good money but there is no way we can afford this.

Any ideas for me?? I am applying to the Genetech Endowment for Pulmozyme, but I highly doubt we will get that big of a break because of our income (which is not high....my husband is a teacher and I work 30 hours from home....but high enough that I don't think we will qualify for anything).

I just don't think its fair at all that they can change what I pay from $80 for a 3 month supply to $345.07 per month! That is a HUGE increase! I plan on writing a letter to the insurance company and to the makers of Pulmozyme, but I highly doubt it will make a difference.

Thanks for your help.
 
M

marcijo

Guest
I take pulmozyme and have been on it for about 6 months now. I went to re-order more via mail order and found out my insurance changed the way prescriptions are paid for. I was paying $80 for a 3 month supply. Now they have changed it (it is still on their formulary, but it is brand name) and I have to pay $345.07 per month! And it is even more expensive to get it at a retail pharmacy (like your local drugstore). Getting it mail order is 20% ($345.07) and getting it retail is 30% ($488.00)!

Can they just change it like this? We cannot afford a $345.07 med payment-and that is just one of the meds I am on! For the vest I am going to have to pay $250 per month for about 16 months (plus meet my deductible of $750 per year). We make pretty good money but there is no way we can afford this.

Any ideas for me?? I am applying to the Genetech Endowment for Pulmozyme, but I highly doubt we will get that big of a break because of our income (which is not high....my husband is a teacher and I work 30 hours from home....but high enough that I don't think we will qualify for anything).

I just don't think its fair at all that they can change what I pay from $80 for a 3 month supply to $345.07 per month! That is a HUGE increase! I plan on writing a letter to the insurance company and to the makers of Pulmozyme, but I highly doubt it will make a difference.

Thanks for your help.
 
L

LouLou

New member
i didn't know they can make changes like this mid plan year. when does your plan year run from and to? Mine starts in August that's why I ask maybe yours is then or Sept. as well which would be likely since I'm guessing you may get your ins. through your husband's teaching job that likely follows an acedemic calendar. Did you possibly forget to review this year's policy?Another thing that might help you is your <b>out of pocket max</b>. My drug plan is the same is the same as your in that I pay a % of my drugs but I have a $1,000 out of pocket max which with cf I meet in the first month I order drugs. <img src=""> When you look it up on your policy's website or call make sure you are looking at drug out of pocket max not medical insurance out of pocket max. Copays for meds and copays for doctors do not work against the same bucket...two seperate out of pocket max's. Hope this helps in some way.
 
L

LouLou

New member
i didn't know they can make changes like this mid plan year. when does your plan year run from and to? Mine starts in August that's why I ask maybe yours is then or Sept. as well which would be likely since I'm guessing you may get your ins. through your husband's teaching job that likely follows an acedemic calendar. Did you possibly forget to review this year's policy?Another thing that might help you is your <b>out of pocket max</b>. My drug plan is the same is the same as your in that I pay a % of my drugs but I have a $1,000 out of pocket max which with cf I meet in the first month I order drugs. <img src=""> When you look it up on your policy's website or call make sure you are looking at drug out of pocket max not medical insurance out of pocket max. Copays for meds and copays for doctors do not work against the same bucket...two seperate out of pocket max's. Hope this helps in some way.
 
L

LouLou

New member
i didn't know they can make changes like this mid plan year. when does your plan year run from and to? Mine starts in August that's why I ask maybe yours is then or Sept. as well which would be likely since I'm guessing you may get your ins. through your husband's teaching job that likely follows an acedemic calendar. Did you possibly forget to review this year's policy?Another thing that might help you is your <b>out of pocket max</b>. My drug plan is the same is the same as your in that I pay a % of my drugs but I have a $1,000 out of pocket max which with cf I meet in the first month I order drugs. <img src=""> When you look it up on your policy's website or call make sure you are looking at drug out of pocket max not medical insurance out of pocket max. Copays for meds and copays for doctors do not work against the same bucket...two seperate out of pocket max's. Hope this helps in some way.
 
C

coltsfan715

New member
Do you possibly have secondary insurance? If so it may be possible for you to pay the copayment and then get receipts and file with your other insurance. That is what we do for some of my prescriptions - mainly when the pharmacy won't file my secondary along with my primary.

Where do you live? I am in Florida and there is a program in the state to help CFers out - if you happen to be in FL then I would make a call to your local CFF Chapter and see if they have paperwork for it. I don't know if it helps with meds, but I know it helps pay for stuff like air filters, exercis/gym memberships and stuff. I am pretty sure it is called CF Abilities or something along those lines - again this is in FL I don't know if they have something like that in other states.

Also I just thought on what Lauren said. When does your year begin with your insurance? I know for my insurance - my primary anyway - the year begins in Oct. I would think that they would have to notify you if the policy was changing - either that or your husbands work would have to make him aware of the change.

I am sorry you are having to deal with this. I wish I could offer more advice/help.

Take Care and I hope it gets worked out soon.
Lindsey
 
C

coltsfan715

New member
Do you possibly have secondary insurance? If so it may be possible for you to pay the copayment and then get receipts and file with your other insurance. That is what we do for some of my prescriptions - mainly when the pharmacy won't file my secondary along with my primary.

Where do you live? I am in Florida and there is a program in the state to help CFers out - if you happen to be in FL then I would make a call to your local CFF Chapter and see if they have paperwork for it. I don't know if it helps with meds, but I know it helps pay for stuff like air filters, exercis/gym memberships and stuff. I am pretty sure it is called CF Abilities or something along those lines - again this is in FL I don't know if they have something like that in other states.

Also I just thought on what Lauren said. When does your year begin with your insurance? I know for my insurance - my primary anyway - the year begins in Oct. I would think that they would have to notify you if the policy was changing - either that or your husbands work would have to make him aware of the change.

I am sorry you are having to deal with this. I wish I could offer more advice/help.

Take Care and I hope it gets worked out soon.
Lindsey
 
C

coltsfan715

New member
Do you possibly have secondary insurance? If so it may be possible for you to pay the copayment and then get receipts and file with your other insurance. That is what we do for some of my prescriptions - mainly when the pharmacy won't file my secondary along with my primary.

Where do you live? I am in Florida and there is a program in the state to help CFers out - if you happen to be in FL then I would make a call to your local CFF Chapter and see if they have paperwork for it. I don't know if it helps with meds, but I know it helps pay for stuff like air filters, exercis/gym memberships and stuff. I am pretty sure it is called CF Abilities or something along those lines - again this is in FL I don't know if they have something like that in other states.

Also I just thought on what Lauren said. When does your year begin with your insurance? I know for my insurance - my primary anyway - the year begins in Oct. I would think that they would have to notify you if the policy was changing - either that or your husbands work would have to make him aware of the change.

I am sorry you are having to deal with this. I wish I could offer more advice/help.

Take Care and I hope it gets worked out soon.
Lindsey
 
M

marcijo

Guest
My plan runs Sept-Aug. I knew the change was coming and checked on it when I first heard about it. For some reason I was thinking pulmozyme was a generic (but I was wrong of course, it is only on their formulary), and the copay on the mail order generics are only $20 fora 3 month supply now! So I actually thought it was going down.

This insurance is my insurance through my work-which I am in charge of! It just seems to get worse every year as far as benefits paid, deductibles, etc....so I may just see if I can get him to change insurance companies next year. We'll see. I checked with my husbands insurance, and to add me on it would be $433.00 per month-crazy! Especially when I am paying $46.00 a month for my plan (my employer pays most of it.

Also-does the out of pocket max cover Rx's too? Because if it does, I'll meet that no problem with the purchase of my vest. I just may have to call and ask about that.

Thanks for the ideas! I just got my packet of paperwork to fill out for the Genetech Endowment, we'll see what comes of that.
 
M

marcijo

Guest
My plan runs Sept-Aug. I knew the change was coming and checked on it when I first heard about it. For some reason I was thinking pulmozyme was a generic (but I was wrong of course, it is only on their formulary), and the copay on the mail order generics are only $20 fora 3 month supply now! So I actually thought it was going down.

This insurance is my insurance through my work-which I am in charge of! It just seems to get worse every year as far as benefits paid, deductibles, etc....so I may just see if I can get him to change insurance companies next year. We'll see. I checked with my husbands insurance, and to add me on it would be $433.00 per month-crazy! Especially when I am paying $46.00 a month for my plan (my employer pays most of it.

Also-does the out of pocket max cover Rx's too? Because if it does, I'll meet that no problem with the purchase of my vest. I just may have to call and ask about that.

Thanks for the ideas! I just got my packet of paperwork to fill out for the Genetech Endowment, we'll see what comes of that.
 
M

marcijo

Guest
My plan runs Sept-Aug. I knew the change was coming and checked on it when I first heard about it. For some reason I was thinking pulmozyme was a generic (but I was wrong of course, it is only on their formulary), and the copay on the mail order generics are only $20 fora 3 month supply now! So I actually thought it was going down.

This insurance is my insurance through my work-which I am in charge of! It just seems to get worse every year as far as benefits paid, deductibles, etc....so I may just see if I can get him to change insurance companies next year. We'll see. I checked with my husbands insurance, and to add me on it would be $433.00 per month-crazy! Especially when I am paying $46.00 a month for my plan (my employer pays most of it.

Also-does the out of pocket max cover Rx's too? Because if it does, I'll meet that no problem with the purchase of my vest. I just may have to call and ask about that.

Thanks for the ideas! I just got my packet of paperwork to fill out for the Genetech Endowment, we'll see what comes of that.
 
M

marcijo

Guest
Oh-and I just called my insurance. My medical stoploss is $2500.00, but apparently there is a different stoploss for prescriptions, it is $5000.00. Which is more than it will cost me to get the pulmozyme for a year. <img src="i/expressions/face-icon-small-sad.gif" border="0"> Can it get any worse? I really hate the prescription drug and insurance industry right now (sorry if anyone works in it). Its just ridiculous the amounts they ask you to pay.
 
M

marcijo

Guest
Oh-and I just called my insurance. My medical stoploss is $2500.00, but apparently there is a different stoploss for prescriptions, it is $5000.00. Which is more than it will cost me to get the pulmozyme for a year. <img src="i/expressions/face-icon-small-sad.gif" border="0"> Can it get any worse? I really hate the prescription drug and insurance industry right now (sorry if anyone works in it). Its just ridiculous the amounts they ask you to pay.
 
M

marcijo

Guest
Oh-and I just called my insurance. My medical stoploss is $2500.00, but apparently there is a different stoploss for prescriptions, it is $5000.00. Which is more than it will cost me to get the pulmozyme for a year. <img src="i/expressions/face-icon-small-sad.gif" border="0"> Can it get any worse? I really hate the prescription drug and insurance industry right now (sorry if anyone works in it). Its just ridiculous the amounts they ask you to pay.
 
N

NoExcuses

New member
Dr. Warwick doesn't put too much faith in Pulmozyme. You might want to check out my blog, Marci, for some alternatives to Pulmozyme. Maybe that will help you


FIGHT ON!
 
N

NoExcuses

New member
Dr. Warwick doesn't put too much faith in Pulmozyme. You might want to check out my blog, Marci, for some alternatives to Pulmozyme. Maybe that will help you


FIGHT ON!
 
N

NoExcuses

New member
Dr. Warwick doesn't put too much faith in Pulmozyme. You might want to check out my blog, Marci, for some alternatives to Pulmozyme. Maybe that will help you


FIGHT ON!
 
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