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What does your insurance do????

Discussion in 'Parents of Children with Type 1' started by fdlafon, Jan 20, 2010.

  1. fdlafon

    fdlafon Approved members

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    My employer switched insurance effective in January 2010 from United Healthcare to Cigna. We are on the copay plan, basically kept the exact same policy, just being provided by a new company. At open enrolment time, at the open forum question/answer session we were told that the pharmacy benefits (provided thru Medco still) would be transparent, and luckily, so far, that seemed to be true.
    UNTIL YESTERDAY when I logged on to order Jordan's 90 day supply of Novolog.
    The price for his Rx went from $118 to $207 :eek:
    That's a pretty significant increase. So, rather than ordering it, I wanted to double check my previous receipt and make sure I wasn't thinkign incorrectly.
    So, last night I check when I get home, and I was right, so I call Medco to inquire.
    Bottom line is that United healthcare treats insulin as a Tier 1 medication and Cigna is Tier 2. So, copays are more, plus Medco did raise the price of the insulin a bit this year as well.

    So, my question for you is this:
    Can you tell me what insurance you have, and what tier your insurance covers it as?

    The reason I ask is because I plan on filing an appeal with Cigna, and also sending the appeal to my benefits department as we were mis-informed, because this is definitely NOT a transparent pharmacy benefit. And I would like to have some info on other insurances.

    If you use Aplus or any of those programs, I can't use them, I've already tried. They won't bill Medco.

    Thanks for your assistnace.
     
  2. Daniel's Mom 1993

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    I wonder if it not the Insulin but the brand that makes it higher - for us if use a One Touch meter the strips for 3 months are $55 but since we have to use Freestyle for our Omnipod it is $95 because it is not a preferred brand whoch I take to mean they have a deal with that company to make them cheaper - we have many drugs like that but Novalog is preferred for us but we also have United Health Care but pharmacy is Catalyst. Check to see if the price fo Humolog is less.
     
  3. Nancy in VA

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    We have that same plan. I don't get the insulin from Medco. I get it from the Target pharmacy and I think the co-pay was $25 for a months supply. We use Humalog - don't know if that makes a difference.

    I use Medco for our test strips and I think I get 3 months for a 2 month co-pay, so $50 for 3 months worth.
     
  4. valerie k

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    I loath our insurance company. What do they do for us? give me massive migraines. We have a 20% co-pay after deductables are met. we also have been graced with high deducts.... Then, to spit in my face further, we have to mail order all of our "maintenance" drugs. I HAVE to get my insulin mail order this year.... I have no choice and Im hopping mad:mad: If not, I can so choose to pay full price for my drugs ( yea right....) at our local pharmacy.:mad:
     
  5. fdlafon

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    Humalog is the exact same price for us thru Medco, so that is not an option.

    These isnurances . . . what a monopoly!
     
  6. zoohouse3

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    Ours is the same way. We each have a $2400 deductible/ $4500 for family. So, when I need to order Rachel's 90 day Novolog supply (12 bottles), it's going to cost me almost $1100 through Medco. Good thing I refilled in December once we had met her ded. so we're ok through March. Gives me time to save up on our HSA card.

    We also had to switch to mail order on insulin this past year. I'm in TX so I was not happy because I just knew it would spoil in the heat. Surprisingly, I haven't run into any problems at all. They are very good about packaging and sending it overnight or however depending on the temps.
     
  7. spamid

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    We have Blue Cross TX (PPO plan), and insulin is covered under tier 2 (brand name, not highest copay). We use Novolog, and pay $30/month copay or $60 for a three month supply through CVS Caremark. We also use A plus medical, but can't get insulin through them.
    Retail cost of insulin is also $30 copay, mail order saves one month. Good luck!
     
  8. fdlafon

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  9. Nancy in VA

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    Well, but most would argue that ALL medicines are necessary to keep people alive - that's why they exist.

    Unfortunately, the way our system is structured, we are tied to what our employers negotiate. I would spend more time getting angry at your employer on what they are negotiating on your behalf because the insurance plan is offering what your employer chose.
     
  10. sammysmom

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    We have HAP (hmo) and brand name drugs are the highest tier at $40.00. But, our plan also stipulates that insulin exclusively would be covered on the lowest tier at $5.00. So we have a pretty good HMO.
     
  11. Toni

    Toni Banned

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    Sis is going from United to HIP this year. Not looking forward to it...... Yeah, I know there are going to be problems.
     
  12. fdlafon

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    Well, I actually received an answer that makes more sense.

    Apparently, United HealthCare uses tier levels as there main way of classifying medications and Cigna uses the brand/generic - Preferred/non preferred method to classify their medications.

    This will make a difference! Insulin does not have a generic, so it will always be a brand. Luckily it is considered a preferred medication by Cigna, so it applys a 25% copay of the total cost as my amount due rather than the non preferred 45%.

    Yes, we are paying $90 more every 90 days, but in the whole scheme of things, that is less than $400 a year. (So I can go without my favorite diet coke from McD's a few extra times this year if need be!) :)
    So, I should just be happy that it worked out this way. It could definitely be worse.
     
  13. Brandi's mom

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    I have Coventry Health Care with RX thru Medco. I am on a PPO thru my employer.

    All diabetic supplies are covered under Tier 2, which for our plan is $35.

    Mail order 3 month supply is $70.

    I only get the test strips and insulin thru them. With the addition of the new quick pens to our regimine the next order will run me $280!
     
  14. denise3099

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    Don't forget to check with your employer to see if you have a flexible spending plan!!! We've had it for years and lots of ppl where I work don't even know about it!! I had to go around to the ppl in my unit and go online with them and help them sign up for it. So check to see if you have one. And if you don't you need to start that conversation with you employer.

    Basically, you can sign up from 250 to 5K annually to come out of your paycheck and into this FSA account throughout the year. It comes out pretax, so your pay is not actually 5K less but maybe 3500 less (it comes out in equal increments though all yr). Then as you spend on health care, you submit receipts and are reimbursed from this account. If on Jan 1 you go to the dentist and drop 5K, you submit your reciept or EOB and are reimbursed the ENTIRE amount even if you've only put in like 200 bucks so far this yr. And if you retire, quit or lose your job, you DON'T have to pay the money back. And you have until I think March of the following year to use it. But if you don't use it, you lose it.

    Find out if you have such a plan--it has nothing to do with your ins.--and if you don't start talking about getting one. It covers copays, scripts, mileage, OTC, laser vision, tons of stuff.
     
  15. Kalebsmom

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    We have Cigna and I also use Target pharmacy. I pay about $56.00 a month for Kaleb's Novolog. I think it is tier 2. It does make me wonder why there is such a price difference for the same med.

    I never much thought about it, but since insulin is life saving, it should be a tier 1.

    This is the second year for us doing a health savings account. We have less than $5,000 taken out. I think this year we did $2400.00 and last year $1700.00. I LOVE it.
     
    Last edited: Jan 20, 2010
  16. fdlafon

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    we do have a flexible spending account. And, I have contributed. It is nice for sure! When I calculated how much we would need, I used last years numbers, just to be safe, so I will have some coming out of my own pocket by the end of the year, but oh-well, it certainly beats the alterior and not having insurance at all!
     
  17. denise3099

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    I know, I used to put in 5K and be out of money by April or June. Last yr was the first yr I actually still had some money left in December. And it hurts to see your pay check. But dd was just dx to need glasses so I'm happy to have it! And they cover all the D stuff we buy at CVS etc. Sure you need to try and save wherever you can but it's nice to have. I'm just amazed at how many ppl don't even know about it.
     
  18. 2type1s

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    Insurance is so weird! We used to pay several hundred a month in co-pays for both girls strips and insulin. Then we started mail-order to save. Then our home-town pharmacy said they'd be happy to re-fill on a 90 day, to keep our business. Our Cigna plan is $5 for insulin and strips since last January. Since there is no generic, diabetes supplies are covered at the lowest teir, like a generic. Cigna stated that most people with diabetes don't "stretch" insulin or put off testing when supplies are more affordable when I questioned this! I felt like I got a raise last year when this happened!
     
  19. hdm42

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    I'm right there with you! DH's company just switched from UHC to CIGNA, and I'm so not happy. UHC covered all our D supplies 100%. I'm guessing they counted it as DME. Not only is CIGNA charging us significant copays ($25 for strips), they also have ridiculous limits on the amount we can get. 100 pen needles for a 30 day supply? Um, he does 4-6 injections a day, you do the math.:confused:
    We've just been to the endo today and gotten all new scripts, and I've asked them to call the CIGNA Dr's override hotline and see if they can get it straightened out for us.
    It's so frustrating :mad:

    We were also told that coverage would be the same as we had under UHC. We were told this both by the company and by the CIGNA reps that came to talk the the employees. DH specifically asked about D supplies and limits, and they assured him that we would be able get whatever we needed without any problems. ha!
    We've made a formal complaint to DH's company, so we'll see if anything happens.
    Yes, we can afford the difference (thank goodness), but it's just not right.
     
  20. twicker1

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    Well, I have CIGNA too, and it sucks! Our percentages are 20%, 40%, and 50%. Insulin and strips fall under the 40%, but they graciously have a $100 cap on a single prescription. That means that every month, I pay $100 for penfills, and $100 for strips. Of course, that is after we meet our $3000 deductible. The company (we're still through the company with COBRA) puts up the first $2000, and we are responsible for the remaining 1000 before we start paying our percentages. Note: two boxes of penfills is about $420. I think we are moving to vials.
     

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