10 replies to this topic

[gianfranko]

Has anyone being able to check the prescription coverage offered by the new healthcare law plans?  I have been continuously trying since 10/01, but the healthcare.gov website is always having some issues.  I was wondering if anyone here had been able to get through and know what is the coverage for prescription medication (copays, deductibles, etc)

[Trey]

This was written a couple weeks ago about the uncertainty of this issue:

http://www.nytimes.c...wanted=all&_r=0

This may help somewhat, if accurate (not sure how they would know):

http://www.usarx.com...t-drug-coverage

I was surprised to see the following:

"The Affordable Care Act requires only one drug per category and class be covered within a health plan formulary"

That would mean the plans would only be required to offer one CML drug such as Gleevec????  I only know what I am reading here, if accurate. 

[gianfranko]

I understand that there was uncertainty about the prescription drug coverage back in September (first link), but shouldn't this information now be transparent in the healthcare.gov marketplace?

Let me check healthcare.gov really quick... here it goes... and there comes the error message:

The System is down at the moment.

We're working to resolve the issue as soon as possible. Please try again later.

[gianfranko]

The information on copays form the second link actually seems nice (hopefully its accurate).  Does anyone know if gleevec would fall under preferred or specialty?

The coinsurance information worries me.  If I understand that correctly, it would require us to pay a certain percentage of the drug cost?  With the high cost of gleevec, even 10% would be prohibitive.  I can't imagine paying 29 - 40%

I can't believe that it has been 8 days and I haven't been able to get any information whatsoever from healthcare.gov regarding the cost and coverage for plans in my state.

[bayclub]

Hi:  One of the most difficult issues I had to face when diagnosed with CML in 8/11, was the fact that I could not fill the prescription at my local pharmacy.  After many searches on the Internet, I finally found Right Source mail order.  Since I am on Medicare Part D plan, I did not qualify for any assistance.  However, the Tasigna meds are approximately $425 per month and I cannot order more than 1 month's supply.  That figure is based on the cost of the ingredients each time I fill the script.  Am I playing the "stock market".  I, too, thought that the Obamacare would alleviate some of the exceptionally high cost of oral cancer meds but as of now, it's not so.  I would highly suggest that all patients be careful when choosing their new plans and you don't have to rush.  A lot of dust has to be uncovered!  I am hoping that more and more research will be found for blood cancer(s) making the drug market more competitive and thus, lowering the cost of these very expensive medications.  Any thoughts,

[Happycat]

I am interested in this topic as well, just in case my dh loses his job. (He's funded by grants, so there's always a possibility they don't get renewed.). I would like to compare my company's drug plan vs. the ACA, but can't for the moment. I'm still fuzzy on my options. I don't know if I can choose the ACA over my company's plan or not. I either won't be able to go with the ACA at all, or I wouldn't qualify for a subsidy. I'm not sure which.

Anyway, I spoke to my mom who is on Medicare. A bunch of her drugs moved from Tier 1 to Tier 4, meaning higher copays, up to 4x as much. I'm a little worried that might be true of the ACA as well.

Traci

[tadly]

In my post in your other topic, I mentioned a Fox news article that is online that compared drug co-pays, in states that are running their own exchanges. Gleevec in particular, was compared, and is classified as a specialty drug.  I think the second link above is giving overly broad averages for your need, in that you want to estimate the co-pays for Gleevec in particular, which is not a typically priced specialty medication.

Your posted earlier that your company was restoring you to your previous position.  Will your family still be covered or not by its health insurance plan?  If you've gone through the qualifications for ACA, you'll see that if your company offers you health insurance, it has to be below minimum coverage standards or "unaffordable" , which is defined as over 9% of your income level, for you to be eligible for getting a new Obamacare plan. If you were brought back as an independent contractor (which I've been for many years), prices and coverage for private, individual insurance, were generally much worse before than now with Obamacare.  The state and federal governments need to address pricing for oral cancer drugs.

[ChrisC]

As of today, Oct. 11, 2013, here in California:

"Among the other bills signed Wednesday by [Governor] Brown:

— AB219 from Assemblyman Henry Perea, D-Fresno, requires health insurers to cap the cost to patients for oral anticancer medications at $200 for a 30-day supply of pills. The monthly cost of chemotherapy pills for patients who have insurance can reach $4,000, according to Perea."

I hope that this also includes TKIs.

[gianfranko]

Tadly,

It is true that at the moment both, me and the wife, will be covered by my company's insurance plan.  I was just curious about what Obamacare offered since I might need it if I am unable to find new employment before the next round of layoffs.  The information I got was actually quite positive (see my last comment).

Also, I am unsure where you got the following information you posted: "...you'll see that if your company offers you health insurance, it has to be below minimum coverage standards or "unaffordable" , which is defined as over 9% of your income level, for you to be eligible for getting a new Obamacare plan."

That statement is false.  The qualifications you stated are to be eligible for a reduced price on an Obamacare plan.  I don't mind paying full price on the plan as long as it is more affordable than COBRA which costs $750 for my wife only.

[gianfranko]

For anyone curious as to my findings:

A Platinum Obama care plan with Blue Cross Blue Shield will cost about $350 per month for my wife only.  Under this plan gleevec costs $150 copay and has a $800 deductible.  I am unsure if the $800 deductible applies also to the pharmacy benefits, but the Obamacare plan offers substantial savings over COBRA (costing $750 per month + $20 copay for gleevec).

Thus, the savings (factoring only the cost of gleevec):

$3240 per year if the deductible is not applied to pharmacy benefits.

$2440 per year if the deductible does apply to pharmacy benefits

[tadly]

gianfranko,

Obamacare in your state seems to offer you a good option for Gleevec coverage. Thanks for pursuing this information.  I think it can be reassuring to others, in similar states, who are or are worried about jobs and losing employer health insurance.

The federal ACA site, healthcare.gov directs people for estimates to the Kaiser Foundation online calculator that I used .  After inputing, it gave me this answer "employees who are offered insurance through work are not eligible for subsidized exchange coverage...".  I understood this as "not eligible", but as you correctly pointed out, all it meant was that, since I already have employer coverage,  if I switched to an Obamacare plan I would not be eligible for the subsidies, such as lowered premium or out-of-pocket costs.

I found it very expensive, for a number of years, to be on individual coverage and with pre-existing conditions after my previous COBRA expired.  I was skeptical that Obamacare could give a better deal than an employer's COBRA coverage.  But I see you're finding it so.