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Meds, Mind, Body & Benefits => Insurance, Benefits Programs & HIV => Topic started by: GoForIt on February 05, 2019, 11:38:43 pm

Title: Copay card no longer counts toward deductible
Post by: GoForIt on February 05, 2019, 11:38:43 pm
Just rudely learned that my copay card does not count toward my deductible when I went to check on my insurance information.  Anyone else run into this?  I am very scared because this has never happened.  I'm reading on Google they changed the way things work now and copay cards won't count toward deductibles anymore.  I was never made aware of this change and now my plan is horrible for me.  Anyone run into this?
Title: Re: Copay card no longer counts toward deductible
Post by: bocker3 on February 06, 2019, 06:37:06 am
I don't use my copay card at the pharmacy.  Rather, I pay for it with my credit card, then submit to the copay card provider for reimbursement.  It generally takes about 3-6 weeks for the check to come -- though you have to be sure that you send them all the info they ask for, else you get a request for anything missing before the check.

If you can swing putting out the copay first, this could be a way around that.

Mike
Title: Re: Copay card no longer counts toward deductible
Post by: GoForIt on February 06, 2019, 11:22:13 am
Thanks for the idea
Title: Re: Copay card no longer counts toward deductible
Post by: kentfrat1783 on February 24, 2019, 10:11:35 am
My insurance hasn't allowed copay cards since January 2018.  I know I posted something about this back in Dec '17 and Jan '18 but no one believed more or thought I got my information correct but as they started to research they soon realized I was correct.  It is just taking time for all of the insurance plans to do the same sneaky underhanded thing.  :(

They also "highly encourage" me to get the Rx's filled through the specialty pharmacy.  I could attempt to do it at the local pharmacy but most that I have called said I had to call their specialty pharmacy.   

I haven't tried or looked into the reimbursement process but could be a way to get around it. 

Hope you can get something figured out. 
Title: Re: Copay card no longer counts toward deductible
Post by: bocker3 on February 26, 2019, 10:17:53 pm
Let's not lose sight of one important fact here.  While not a huge fan of insurance companies, the problem with co-pay cards is that they allow the Pharma companies to have high prices, but lessen the impact to the patient.  While that SOUNDS like a good thing (and in the short term, it is) it lessens the pressure on them to lower prices and bring them close to a realistic level.  Why?  because if I'm not feeling pain over paying, then the "pain" all falls on the insurance company.  Which, of course, comes back to us in the form of higher premiums.

So -- the insurance company is trying to ratchet up the pressure on Pharma by making patients feel more of the pain of high drug prices.  (and, of course, help protect their own profits too).

Bottomline -- This isn't all about the big bad insurance company -- it is ultimately more (IMO) about the immoral Pharma pricing schemes. 

M
Title: Re: Copay card no longer counts toward deductible
Post by: Ptrk3 on April 23, 2019, 06:43:55 am
From the April 23, 2019, edition of (online) POZ magazine, this could be a welcome game-changer for affected folks (those on HIV-medication without generic equivalents) as it plays out:

https://www.poz.com/article/centers-medicare-medicaid-services-bans-copay-accumulators

Lede from story and first paragraph:

"People with a chronic illness who need to buy brand-name drugs may be able to save money on their meds thanks to the Centers for Medicare and Medicaid Services (CMS). The federal health agency issued a regulation that bans what are called co-pay accumulators from applying to brand-name drugs for which a generic version is unavailable.

This means that insurers and pharmacy benefit manufacturers (PBMs) can no longer prohibit co-pay assistance provided by drug companies from counting toward a patientís cost-sharing requirements. According to a press release by The AIDS Institute, the ban on co-pay accumulators was included in the Health and Human Services Departmentís 2020 Annual Notice of Benefit and Payment Parameters."

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