PSA about your medication: Your insurance plan might start demanding cash prices much more often

[steve2470]

Background: I have a gold-ish insurance plan with Blue Cross Blue Shield of Florida. Normally I pay my "pharmacy deductible" in January and February, and the rest of the year I pay the insurance price ($80) for one of my meds per month.

In June, BCBSoF decided to change their insurance contract with me and others on my plan without informing us by email or paper letter or phone call. Now, my medication cost for this med always goes to the $6700 deductible (ugh), which it did not demand before June 2016. Now, I have to pay $295 a month for this med all year unless my deductible gets satisfied somehow, which it normally never does. I'm grateful that it never gets satisfied, but yes, paying cash all year is a shock to my system. Yes, I verified all these facts with a 30 minute phone call to the pharmacy contractor for BCBSoF. Apparently they did this to everyone on my plan without notifying us.

It's the middle of the year, so you can't change insurance plans unless you have a "qualifying event", which I do not. I have to wait til open enrollment which is in October I think.

I want single-payer for all/Medicare for all. These kind of events will eventually force it or, much worse, force a regression back to the old system, which sucked for many many people.

Best wishes to you with your health and your health care.

on edit: Of course, I'm going to talk to my doctor about a generic medication instead of the pricey name-brand one. AFAIK, there is no generic substitute for my current med, so I'll have to take a totally different one.

[yourpaljoey]

1. Damn. What do the Bronze Plan people do... suffer and die young?

Such a scam.

[steve2470]

2. about the size of it, yep, and pretty soon I will be a Bronze plan person

I think almost everyone will be, eventually, unless things are radically changed.

[yourpaljoey]

5. How often, while waiting in the pharmacy line, have you seen people who cannot afford the script?

Either they opt for five or ten of the thirty pills they needed, or walk away
empty-handed. Embarrassing, demoralizing, perhaps a death sentence.
There is one medicine I would die without in about seven days.
And not die nice.

[steve2470]

7. yes, I have the greatest of empathy for people like you

Without my med (or one very similar), I would have a pretty wretched life. You're right about the people in the pharmacy line. It's not right, and it needs to change for everyone.

[yourpaljoey]

12. Years ago I did run out, for two days

Boy, they were not kidding about absolutely needing that
stuff every single day. By day three I was in the ER, BEGGING for
more.
I learned my lesson well, now I keep an extra (rotated) supply
in my desk AND in the auto as well as on the morning drug tray.
Better life thru chemistry

[steve2470]

13. best wishes to you! nt

[1monster]

14. We pay the premium every month and get NOTHING in return...

I had a silver plan for a year and paid around $700 per month in premiums and got a $25.00 benefit for one doctor visit for an eye exam. The rest of my medical needs were paid by me out of pocket.

This year I have the lowest price insurance I can buy and I will get no benefit from it whatsoever. The premium for my silver plan went up to nearly $900 and the benefits were even less, so I dropped it.

I figure I'm just gifting the insurance companies every month when the payment goes out. And it ticks me off!

[Nye Bevan]

15. Except that if you got cancer or some other disease, or got into an accident,

and needed a million dollar's worth of treatment, the insurance company would pay for that in full, less your out of pocket limit. Like paying for homeowner's insurance, your premium is getting you real protection against a disaster scenario and is not really a "gift".

[Aerows]

18. Maybe they would

if you take them to court and sue dragging it out for several years. You are far too optimistic about insurance companies if you think they won't fight tooth and nail to hold on to every dollar they have ever been given.

A million dollars worth of treatment? You must be joking. You'd die before that bill ever got paid.

[Nye Bevan]

19. Of course they would, without question, if you stayed in network.

The only possible issue would be "balance billing" if you got treatment out of the network. But in-network you would just get the treatment and the providers would be reimbursed directly by the insurance company, no lawsuits necessary. Now that pre-existing condition exclusions have been banned by the ACA there would be no grounds for refusing treatment.

[strategery blunder]

20. The biggest remaining problem is out-of-network providers hanging out at in-network hospitals.

You can go to an in-network hospital to get your tumor removed, but the surgeon is an out-of-network contractor, and the hospital might not bother to tell you.

So insurance says "out of network" and refuses to pay, leaving you with a medical bill larger than your mortgage.

Perfectly legal in most states.

[SickOfTheOnePct]

3. When you had the pharmacy deductible

What were you paying in Jan and Feb for the meds?

Also, if there is a generic available, I would have already been asking for that instead of the name brand.

[steve2470]

4. in those months I was paying the $295 for it, which was manageable

The medication works extremely well for me, so I'm loathe to change. However, this event forces my hand. If I can take a generic (which will be a different medication altogether) and get the same benefit (or very close to it), I'll take it.

Let's not get away from the premise of my OP: I think this is going to happen to more and more people, and this will force a change, either for good or for bad. We'll see. We'll have to mobilize for the good choice, which is single payer.

[yourpaljoey]

8. Good luck on that generic. I have tried some that did not work at all.

It's hit or miss.

[steve2470]

10. there is no generic for my med right now because it's still under patent

I'll have to take another one, unless I get a break somehow from the manufacturer.

[SickOfTheOnePct]

11. I understand the premise of your OP

I just disagree with your terminology. You're still paying the insurance price, as negotiated by the BCBS with the pharmacy, not the cash price. You're just having to do it without any help from the insurance company.

[WhiteTara]

6. can you contact the manufacturer of the drug

and ask for "extra help" sometimes, they give special prices or just give it to you. It's worth the try.

[steve2470]

9. good idea

I'll talk to my doc first, and see what she says. Then I'll do what I need to do, including that option.

[dixiegrrrrl]

16. Be aware if you want to take a whole different one.

I tried to substitute one generic drug for a similar one, because of no warning price hike.
and my pharmacist wisely suggested I only get 10 pills, instead of the whole script, just in case they did not work.

The new pill gave me side effects I do not want to repeat.

Luckily, I was able to get the old drug at the original low price elsewhere in town.

[steve2470]

17. yes good advice thanks! nt