Sigh. Well, for a brief shining moment my pharmacy troubles were over. But now I am back where I was a year ago, with a letter from the insurance company telling me that they won’t let the pricey Gilenya count toward my deductible, because I’m not the one paying for it (the co-pay assistance organization is).
It’s okay: it means that the MS medicine is in a separate financial box, and is still covered up to $15,000 a year by the lovely co-pay assisstance people. In the future I pay all the parts my insurance doesn’t cover (around $1,000 a month) and then that amount is reimbursed. If I had some catastrophic accident that would still satisfy my deductible. (The deductible went up 25% last year, as well.)
So, essentially, I’m in the same situation as everyone else, paying high premiums for a high deductible I will hopefully never use.
Amusingly, just with his normal medication and a colonoscopy, Gary came a few hundred dollars away from his deductible last year. I take some vindictive satisfaction in that.
And for all who say, “That’s outrageous, you’re still paying the money, why would the insurance company care where the money comes from,” read the article on the new law in Virginia and West Virginia that make these insurance shenanigans illegal. The insurance company claims it has to do this to shine a light on the high prices charged by the drug companies.
I feel a little like a child of divorce, with Daddy Drugs and Mommy Insurance fighting over who is best as taking care of me, and I’m caught in the middle.
2 responses to “Public Service Announcement Part 3, in Which I’m a Little Annoyed”
Deductibles are weird in health insurance to begin with.
We used to have a landlord who was accustomed to having college student tenants, and his rules for when to call him/not call him were kind of hilarious, but basically boiled down to: “you can change a normal lightbulb, so don’t call me to change your lightbulbs.” – and that sort of “deductible” makes sense to me, where no, please do not file a homeowner’s insurance claim for a repair that costs less than $50, it just isn’t financially feasible to plow through the paperwork for that sort of cost. But health insurance, they’re already keeping track of it, they’re already paying part of it… eh.
That they’d get cranky about co-pay assistance, because higher co-pays for expensive drugs are part of how insurance, uh, “encourages” people to “reconsider” expensive drugs: that makes sense to me, from a brutal business no-ethics-no-morals-just-money viewpoint. (I hate that viewpoint, but whatever.) If they can’t make you pay the copays, then at least they can not let it apply to the deductible.
It’s odd, with pharma and drugs and insurance in the US; yes, Big Pharma pays big money to do some of the medical testing for medications that otherwise wouldn’t exist anywhere and then passes on some of that price tag to US customers; the US government pays for some testing and research for free; insurance is having to figure out, given that there *are* medical options out there with astronomical price tags that a given individual’s paying-in-to-the-system amounts would never possibly cover, what to do about that (and being skeezy and way more profit-driven than should be allowed, incidentally, as Big Pharma often is; but even if they weren’t bogglingly corrupt in spots, we’d still have some cost/access problems… just a lot fewer. Sigh.).
KC – It’s made by a Swiss company, so no US funding here (thought there was that potential scandal involving access via Michal Cohen). I wonder if it’s cheaper in Switzerland. It was interesting to find that the actual cost, spilt between the insurer and patient is “only” $3,000 a month. Perhaps I should be hoping for the generic.