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  1. #1
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    Insurance and drug costs

    Post by tetra on 1 minute ago

    I just finished investigating 2019 drug costs under my Medicare Advantage Plan, which I've been in now for 3 years. Sneaky details:

    I've used the mail order drug delivery service for 3 years because with my previous, employer sponsored plan (also though UHC), it was the cheapest option. Ahh, the devil in the details. Somehow I missed that my current Advantage plan has a somewhat complicated system wherein drugs above Tier 1 have varying co-pays depending on whether you use mail service or a local pharmacy:
    Local Mail service
    Tier 1 $0 Copay $0 Copay
    Tier 2 $9 Copay $0 Copay
    Tier 3 $47 Copay $131 Copay
    Tier 4 $100 Copay $290 Copay
    Tier 5 33% Coinsurance 33% Coinsurance

    So, Tier 5? You'd best not need that!

    Ibandronate sodium for bone loss is a tier 3 drug. My others are tier 2. The Final tally is I will save $164 in 2019 if I switch to local. That is a useful sum although the mail order is wonderfully convenient.

    The second surprise, however is that they changed baclofen and gabapentin to Tier 2 drugs, where they were tier 1 in previous years. I am suspicious this may mean that next year they will up the price. We really have to keep an eye on these folks.

    The bone loss drug is particularly vexing because my test results do not indicate any benefit from the expensive drug. On the other hand, one can argue that maybe my results would have been worse without it.

    It would be useful to hear of other people's experiences with insurance coverage for medications.





  2. #2
    Quote Originally Posted by Tetracyclone View Post

    The bone loss drug is particularly vexing because my test results do not indicate any benefit from the expensive drug. On the other hand, one can argue that maybe my results would have been worse without it.

    You don't mention what bone loss drug you're taking, but if it's one of the bisphosphonates, I think there is pretty good evidence that those do nothing for loss of bone density in SCI. Don't have the studies at my fingertips right at this moment, but I seem to remember looking that up a few years ago.

    Maybe you can get by without spending so much money on it?

  3. #3
    BONIVA (ibandronate sodium) is a nitrogen-containing bisphosphonate.

    (KLD)
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  4. #4
    Senior Member Joe-MN's Avatar
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    You need to look at how long of a supply local vs mail order allow. In the past, local was only 30 days, but mail order allowed 90 days.

    Not sure it that is still the case because I recently got a 90 day supply from a local pharmacy.


    Quote Originally Posted by Tetracyclone View Post

    Post by tetra on 1 minute ago

    I just finished investigating 2019 drug costs under my Medicare Advantage Plan, which I've been in now for 3 years. Sneaky details:

    I've used the mail order drug delivery service for 3 years because with my previous, employer sponsored plan (also though UHC), it was the cheapest option. Ahh, the devil in the details. Somehow I missed that my current Advantage plan has a somewhat complicated system wherein drugs above Tier 1 have varying co-pays depending on whether you use mail service or a local pharmacy:
    Local Mail service
    Tier 1 $0 Copay $0 Copay
    Tier 2 $9 Copay $0 Copay
    Tier 3 $47 Copay $131 Copay
    Tier 4 $100 Copay $290 Copay
    Tier 5 33% Coinsurance 33% Coinsurance

    So, Tier 5? You'd best not need that!

    Ibandronate sodium for bone loss is a tier 3 drug. My others are tier 2. The Final tally is I will save $164 in 2019 if I switch to local. That is a useful sum although the mail order is wonderfully convenient.

    The second surprise, however is that they changed baclofen and gabapentin to Tier 2 drugs, where they were tier 1 in previous years. I am suspicious this may mean that next year they will up the price. We really have to keep an eye on these folks.

    The bone loss drug is particularly vexing because my test results do not indicate any benefit from the expensive drug. On the other hand, one can argue that maybe my results would have been worse without it.

    It would be useful to hear of other people's experiences with insurance coverage for medications.




    Better to remain silent and be thought a fool, than to speak and remove all doubt.

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