Express Scripts forcing me to mail order questions

[madeindetroit]

I have blue cross blue shield FL with express scripts.  I have a 150 copay that gilead picks up with my copay card.  I am on Stribild which is rather pricey.   

Heres my questions......this year on my renewal they are saying that only 2 fills will be eligible for retail pharmacy coverage and the rest MUST go thru mail order for my drugs to be covered.   My copay is increasing to 200.  I have heard that I can not use my copay card for mail order.   Do I need to prepare myself financially for the hit ?   Since starting Stribild in Aug of 2015 I have paid nothing for my meds at the local pharmacy.  Grateful for that


UGGGGGGGGGG to many choices on my health benefits at work.   I know someone out there has some answers for me

[Ptrk3]

Check with contacts at the co-pay card to make sure you can't be reimbursed for mail order.  Some co-pay cards do reimburse for mail order.  There are forms to fill out and receipts to turn over, and you do have to pay upfront, but some will reimburse you.  It's just not as convenient as retail where the co-pay is upfront and there is no hassle.  Check out the co-pay website or call the co-pay customer service people during the business week to see if you can be reimbursed for mail order.

[BKKKevin]

I thought there was a class action suit that settled this problem... You should be able to opt out of the mail program... Contact them and state that you have privacy issues have the drugs mailed to your home and that the mail in unfairly causes you financial burden as you can not take advantage of the company reimbursement...

Read more here and tell us how you make out...

http://www.consumerwatchdog.org/case/blue-cross-allow-hivaids-patients-“opt-out”-mandatory-mail-order-rx-drug-program-blue-cross-set

[Mightysure]

I'm on Stribild, have BCBSNC and I use Gilead's copay card and they cover my mail order script. It's just like any other pharmacy to them.  If there's an issue with your insurance company accepting copay assistance with mail orders that may be a different story.

[ColoradoSkiFanatic]

Hey MadeInDetroit... I'm just about a year into this new adventure, and I've been using express scripts (stribild) since about Feb 2015.  It is true that they do not honor the co-pay assistance card, but Gilead reimburses me directly... I just send in a form with the labels off the bottles along with the invoice and I get a check in a week or two.  Here's the website:

https://www.patientrebateonline.com/patientrebate/welcome.html

I had some problems getting set up with Express Scripts at first, but since then I have to admit they've been great.  Refills are automatic and always get to me well before I need them.  So really, no complaints.

Also, I'm on a high deductible plan, which means I pay 100% of charges (out of a pre-tax HSA) up to the deductible (like $3K, max out of pocket $5K).  Sounds bad, BUT, just one 3-month fill and I hit my max out of pocket, which is completely reimbursed by Gilead.  So basically, Gilead is paying my deductible, and after that, all the labs and dr visits are covered completely, $0 copay.  Premiums for this plan for myself, husband, and daughter are completely paid by my employer (Thank you Intel!).  For standard insurance options, premiums would be something like $6K/year for the 3 of us, so it's a great deal.  If you have a similar option, you might look into it.  High deductible plans are getting popular due to low premiums.

[madeindetroit]

Thanks everyone for the info.....I am getting it all sorted out.  I just paniced at first when I read my new insurance info.