Drug Co-pays... any thoughts on reducing $$?

[marky]

I thought I'd throw this out to everyone here...... I'm with Wellmark Blue Cross with an individual plan.  I have to buy my own insurance since I'm self employed.  My drug co-pay is 25%.... with no limit.   Anyone here have any suggestions on how I might cut that expense down?  Anyone have any thoughts on other health insurance companies that might be better when it comes to this cost?  Any ideas would be appreciated.  PS: I am self employed, so no, I can't get on a company plan. 

Also.. if any of you are on an individual plan... what are your co-pays? 

Thanks. 
Peace out.

[BT65]

Sorry, I don't have any advice on this.  I'm on Medicare Part D.  Maybe someone else will know something.

[aztecan]

Hey Marky,

Boy, 25 percent?!? That could add up to a chunk of change.

Would it be possible for you to get your meds filled at a clinic pharmacy or similar operation that uses a sliding scale fee?

I know some people who do that for non-HIV meds and it is more cost effective for them. It would depend on what your income is.

HUGS,

Mark

[Robert]

How often do you renew your prescriptions?  Monthly?  Most pharmacies allow you a 5 day grace period, meaning  you can pick them up 5 days before the end of the month.  If you do this every month, then after 5 months you'll be up 25 pills and after a year, you should be just about 2 months up on your pills.  Now I'm AIDS impared so maybe my math or logic is wrong, but it might be worth looking into.

Also, are you religious about taking your pills daily?   Don't ask me why, but every 8th day I skip my pills which is like 3 pills leftover every month.  This also adds up.

robert

[marky]

Mark:  I'm in that unfortunate (or maybe fortunate) category where I make too much money/ and or have too many assets, so I can't really get meds from the "system"...... Robert:  I get my meds from mail order .. usually a 3 month supply at a time (which means my copay every 3 months is $$$alot).  As far as skipping doses... hmmm, not really looking at that option.  I have considered taking a long break, but that also doesn't really seem like a smart idea.  I'll just keep asking for suggestions and who knows.. maybe someone will have a the answer.. if not, I'll just keep paying the big bucks$$$ 

[brooklynpoz]

Hi Marky ,

Try calling ADAP ( aids drug assistance program ).
They help the under insured.

1-800-542-2437

[buca45]

That too is my advice. I am on a domestic partners insurance and use their pharmacy to get three month supplies of drugs i need. yes, copays are very high, but by getting 3 mos supply, it does save alot of $.
I also am on ADAP and because of being on SSDI as well, they pay for all copays for both meds and for doc/specialist visits as well.
I am assuming that each state is different...NY covers all copays while in Florida, only 75% of copays were taken care of.
Definately contact ADAP or have your ASO counselor contact them for you to see if this is avaliable to you.
good luck

[allanq]

The only thing I can think of is to go over all your prescriptions with your doctor to see if there are any lower cost meds that you can be taking, like generics instead of brand names, or maybe a less expensive HIV drug. For example, Norvir is very expensive. If your regimen includes a PI with a Norvir booster, a change to an unboosted PI or another class of drugs could save money.

I think it might be difficult to switch insurance carriers at this point. Most carriers would deny coverage on an individual policy if you have a pre-existing condition.

Allan

[fearless]

Join a clinical trial if you can. they usually supply the drugs free of charge

[MitchMiller]

Actually I think 25% copay is probably a great deal.  I'm actually amazed you can get insurance at all.  Do you use insurance offered by the state you live in?  I knew one guy that had State insurance and his copays were 40%.  Given that 3/4 of your monthly meds cost is a given, I would think the premiums would need to be even higher than that.  A friend of mine that is on medicare/medicaid/adap called around to get some supplemental insurance and was flatly turned down everywhere he looked.  My PA told me I would be considered uninsurable by private insurance co.'s. 
Just curious how you managed to get covered.

[aztecan]

Hey Marky,

Is is possible to get your meds by mail order? Usually, they will charge either only one or two months copays for three months prescriptions.

Its a thought.

HUGS,

Mark

[edfu]

Mitch,

Insurance regulations vary from state to state.  In New York, for example, an insurance company cannot legally turn down any application for individual coverage, although they can impose up to a 12-month waiting period for coverage of a preexisting condition--unless you were previously covered under a group plan and did not have a no-insurance gap period of more than 63 days.  In the latter instance, they are required to recognize your previous coverage and may not impose a waiting period at all if the previous coverage lasted for at least 12 months.  This is, admittedly, more generous than most states. 

[md]

Hey Marky,

Is is possible to get your meds by mail order? Usually, they will charge either only one or two months copays for three months prescriptions.

Yeah, that helps in most cases where there is a per-prescription copay. but according to Marky his co-pay is 25% of the actual cost with no limit so I don't think that getting a 3 month supply instead of 1 month will help 

[sharkdiver]

Hey there,
I live in California and work for a small private practice. My employer changed our Kaiser insurance, since deductibles were going through the roof. We have a health savings account. It is set up like a TSA (tax sheltered annuity) .  I take money out each month before taxes and put it in this account and my employer puts in an amount. There is, however a total annual $1500 deductable with no cap. There is a maximum individual contribution of 2500. The first time I get my meds , yeah its a bit much, but it is better than the actual price, plus everything else is covered.  Over time you save a bunch of money as well as have a retirement account.  I'm not sure how it would or if it could work out for those self-employed, but you might want to check out.

thought I'd throw it out there
sharkdiver

[marky]

wow... lot's of thought/ ideas.... first off, I had insurance PRIOR to my HIV.. so i never had a pre-existing condition.  Second, I do get my meds from mail order... and they are actually cheaper than the "street" drug store, however I don't get a break on the copays......and I make too much money to go on any public assistance (which is i guess a good thing.. otherwise I'd have to be in poverty)......I figured it out and the copay for me costs around $3500 per year.......but my partner is also HIV and his co-pay is like $6,000 (he has designer drugs I think!!).  Can't wait to get some universal health care in this country..... damn re"thug"licans anyway! 

thanks guys.