You Wouldn’t Believe Me If I Told You

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You Wouldn’t Believe Me If I Told You

By Claire Sachs
The Patient Advocate’s Chronicle 
July 18, 2019

So, insurance. Can’t live with it, can’t shred it to bits in a fit of policy-induced madness. I’m sure I’ve said that before, but really, can you say it too many times as a chronic or autoimmune patient dependent on insurance for any chance of financial stability?

The answer is no.

Today, I give up. My policy doesn’t deliver medication on time, loses prescriptions, and generally doesn’t use common sense at all. (If I tell you it’s an emergency, don’t wait for all the prescriptions to come through to send one that I need.) I shouldn’t be surprised since my current insurance company recently acquired a pharmacy benefits manager I was convinced was trying to kill me until my previous employer dropped them like a hot potato when too many employees complained. I am happy to say they are living down to expectations.

This week, I needed to renew a prescription. Under my previous plans, the co-pay was $0. I learned at the beginning of the year that insurance would pay for approximately $32 of a $480 three-month prescription. It was upsetting – the Affordable Care Act dictated that this type of prescription be covered, but not which specific meds. I’d just assumed that my specific med, covered completely by plans for the last 15 years, would be covered by this one. Plus, I hadn’t planned for that when I decided my Health Savings Account contributions. It would definitely mean not getting everything I needed this year.

I quickly researched manufacturers’ coupons, and found one that brought the cost down to $155 for three months, or $55 for one month. Doable, but still a lot more than I had planned for.

Today I arranged my refill, and the pharmacist said that my insurance would only cover one month. Did I still want three months? As far as I knew, my insurance didn’t cover any of it. Well, 7%, but why quibble over $32? Curious, I asked what the co-pay would be for one month. She said $42. I was surprised, considering what I had been told in January. But ok, $13 was $13 in my pocket.

Still curious when I reached the pharmacy, I pulled out my manufacturer’s discount card to see what would happen if the pharmacist ran my now covered(?!?) prescription through with the company discount. Lo and behold, it came to $25! Now, that I can handle. It does make me wonder whether I overpaid by half the first six months of the year ($155 instead of $75), but at this point, I don’t have the energy to look a gift horse in the mouth.

Just goes to show: as much as you know about your insurance policy – and I know a lot — you are still subject to the whims of the company. This time it ended up in my favor. Usually it doesn’t. But how do you plan for that?

You can’t.

So, good or bad, on this plan, I give up.

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