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Author Topic: end of study need to start using insurance  (Read 243 times)

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Offline gorka

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end of study need to start using insurance
« on: November 28, 2018, 01:32:36 pm »
hi everyone need your advice.  I am at the end of bactigravir study and at this point I  still dont know what I am taking(either bactigravir or dolutegravir).  I have Cigna.  The study team wants me to return all remaining medicines this month and start prescription.  I will have to return the meds and then with voucher go to pharmacy and get medication.  They are giving us a voucher to cover out of pocket cost medications to meet deductible.   my understanding is that the voucher is not per calendar year but from the day you got it and will cover 6k or 7k up until same day next year.  again I dont know what I was taking either bactigravir or dolutegravir.    I wanted to start from next year but they wont allow it.   I need to confirm if I can use voucher this year and next year or is it just one time per calendar year until deductible is met.  any advice in this unique situation?

Offline gorka

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Re: end of study need to start using insurance
« Reply #1 on: November 28, 2018, 01:44:37 pm »
another question is do u you know if cigna is using co-pay accumulators where despite having a voucher you are asked to pay out of pocket as well?  not clear from cigna site

Offline Ptrk3

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Re: end of study need to start using insurance
« Reply #2 on: November 28, 2018, 01:55:15 pm »
I strongly suggest you get on a three-way call with the issuer of the voucher and a Cigna customer-service representative to discuss and fully understand how your voucher may be best applied pursuant to the terms of your Cigna policy.

I don't want you to get incorrect advice from forum members, no matter how well-intended that advice may be.
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Offline Ptrk3

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Re: end of study need to start using insurance
« Reply #3 on: November 28, 2018, 02:01:58 pm »
As to your "copay accumulator" question, you also need to ask Cigna or, perhaps, review your Cigna pharmaceutical benefits and see if there is any language about "co-pay" accumulation.

I understand exactly what you are writing about, as some insurers are adopting "co-pay" accumulation language to assure that co-pay assistance benefits do not apply toward the policy-owner's deductibles or max-out-of-pocket for any given year.

Start with "googling" co-pay accumulator and Cigna, and see how far you get.
HIV 101 - Basics
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline gorka

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Re: end of study need to start using insurance
« Reply #4 on: November 28, 2018, 02:29:02 pm »
it looks like express scrips/medco  is using co accumulation.   That is contracted pharmacy for Cigna and i get my other meds through them.   
« Last Edit: November 28, 2018, 02:44:51 pm by gorka »

Offline Ptrk3

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Re: end of study need to start using insurance
« Reply #5 on: November 28, 2018, 07:02:46 pm »
I don't pretend to know how Cigna interacts with its contracted pharmacy, so maybe Cigna still allows co-pay assistance to count toward your deductible.  Sometimes these things are very nuanced and, perhaps, the language in your policy is controlling over the pharmacy contractor?

Once you know for certain, you may also check to see if you have a mail-order option (unless, of course, express scrip is only mail order).  You would be surprised how much mail-order can be cheaper than retail for certain drugs.  Again, review your pharmacy formulary (for 2019) to be fully informed of all your options.
HIV 101 - Basics
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline gorka

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Re: end of study need to start using insurance
« Reply #6 on: November 28, 2018, 07:59:46 pm »
yes you are correct looked into it further.   sounds like 3 month supply through expres scripts is a little more expensive than 1 month supply with contracted pharmacies that bill expres scripts.  that said its not clear at all if u can use co pay assistance on mail orders (seem you can) and if it counts at all towards reducing your overall out of pocket (seems that it does not if you  do mail order).  I need to study this more.  there were some thread on here suggesting to use contracted pharmacies first until reaching the out of pocket max and then switch to mail one.  ughhh.  this is like a labyrinth. 

Offline gorka

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Re: end of study need to start using insurance
« Reply #7 on: November 28, 2018, 08:05:32 pm »
and i checked with cigna as well and they said that my prescription benefit is fully with express scripts but that  my prescriptions co pays count towards maximum out of pocket for my insurance.    so this should really be express script thread I guess.  insurance is so confusing.  just worrying i will make some mistake that will require me to pay 6k until i hit my maximum out of pocket. 

Offline Ptrk3

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Re: end of study need to start using insurance
« Reply #8 on: November 28, 2018, 11:58:02 pm »
With mail-order, you may need to "front" the co-pay, then apply (using forms provided by the party providing the co-pay assistance) for reimbursement (from the party providing that co-pay assistance).

True, depending on your co-pay assistance maximum per calendar year, it may be worth it or necessary to switch from retail pharmacy to mail order during each calendar year, if you reach the maximum for co-pay assistance (and back again each calendar year, as in "rinse, repeat").

Yes, insurance with co-pay assistance can be a labyrinth, but is well worth the time, focus, effort, and hassle to sort out. 

No matter how complicated, it can be sorted out: it's the math of money (each insurance year).  Once you figure it out, you can go forward with eyes wide open (until it's changed, of course, and then you need to develop a new strategy).

Good luck to you, and continued good health!

HIV 101 - Basics
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

 


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