Extremely important info regarding insurance changes for high price medications [like Humira]

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Date Joined Nov 2003
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   Posted 4/20/2008 6:17 PM (GMT -6)   
Many medical insurance plans have open enrollment periods in July through December. It is very important for everyone taking medications like Humira, Remicade, or other expensive drugs to carefully check the policy options they are being offerred. As many already know, all policies are not created equal. Recent news stories have outlined how insurance companies are instituting a Tier 4 for expensive medications. [Read the NY Times article: Co-Payments Soar for Drugs With High Prices]
This new tier is being modeled after ones instituted by Medicare drug plans. Instead of fixed formulary charges like $10, $20, and $30 dollars for 1,2, and 3 tier medications, the 4th tier charges patients a percentage of the drug's cost. The NY Times article cites this percentage as anywhere from 20 to 33% of the medications cost. This change could make certain meds unaffordable.
Also, anyone that has Tricare - be advised that Enbrel and Kineret are being moved to Tier 3 as of June 18, 2008. As I see it, this means Humira is likely to follow suit in the near future. Make absolutely sure that you order your Humira by mail or from a Tricare Network Pharmacy. Tier 2 drugs [Humira] ordered from a NON-Network Retail Pharmacy will cost 20% of the ACTUAL cost for a 30 day supply.
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CD, Ankylosing Spondylitis, small fiber peripheral neuropathy, avascular necrosis, diffuse connective tissue disease, Sjogren's Syndrome ?

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Date Joined May 2005
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   Posted 4/20/2008 6:25 PM (GMT -6)   
What is worse is that more and more employers do not offer a choice. There is only one health plan. So unfortunatly, informed or not, there is nothing these employees can do to change their situation short of finding a new job.
26 Year old married female law student.  Diagnosed w/ CD 3 years ago, IBS for over 10 years before that, which was probably the CD.  I am sort of lactose intollerant too but can handle anything cultured and do well w/ lactose pills and lactaid.  For crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn.  I also have bad acid reflux and have been on PPI's since age 13.  I have been through prilosec, prevacid, and nexium.  Currently I am on Protonix in the morning and Zantac at night.  I alos take a birth control pill to allow some fun in my life.

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Date Joined Feb 2007
Total Posts : 734
   Posted 4/20/2008 9:58 PM (GMT -6)   
Very good important advice. Thanks so much for sharing. My husband is changing jobs and so insurance and this came at a great time. Thanks again, everyone here does such a great job! You are appreciated!
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