Spiky Bugger
Well-Known Member
- Joined
- Jan 5, 2014
- Messages
- 6,213
Mr. Sue uses a couple of Tier 4 (aka expensive) drugs. Without insurance, his Otezla sells for about $1800 for a 30 day supply and his Humira runs $1800-2400/mo.
Last month, his second month on Medicare, his copay for those two was zero.
Today he tried to reorder. He has to use the cheapo pharmacy to get the best coverage. Debbie the pharmacy lady wanted $95 for the Otezla and $190 for the Humira. She kept explaining that it's a new year and he has new deductibles. Mr Sue's wife said, "We'll get back to you on this," and called the insurance company.
We then called Clifford, insurance dude. He put us on hold a lot and then returned saying, "You don't HAVE a deductible and your copay on these drugs is $5 per prescription."
So, I gave Clifford Debbie's phone number and we are on hold while they bicker with each other.
But...what if I had assumed Debbie was right? I'd be out close to $300.*
I know that Debbie COULD BE right, and we MAY have to pay that, but I'm hoping Clifford is spot-on on the $5 thing.
* She might be ALMOST right! But she seems to be applying the price for 90 days ($190) to a 30-day prescription. Worst case, we'll pay $190 for each Rx, but that will be a three-month supply of each, which works out to $63/month, instead of $95/month, per drug.
Mr. Sue may LOOK LIKE a cheap date, but looks can deceive.
Last month, his second month on Medicare, his copay for those two was zero.
Today he tried to reorder. He has to use the cheapo pharmacy to get the best coverage. Debbie the pharmacy lady wanted $95 for the Otezla and $190 for the Humira. She kept explaining that it's a new year and he has new deductibles. Mr Sue's wife said, "We'll get back to you on this," and called the insurance company.
We then called Clifford, insurance dude. He put us on hold a lot and then returned saying, "You don't HAVE a deductible and your copay on these drugs is $5 per prescription."
So, I gave Clifford Debbie's phone number and we are on hold while they bicker with each other.
But...what if I had assumed Debbie was right? I'd be out close to $300.*
I know that Debbie COULD BE right, and we MAY have to pay that, but I'm hoping Clifford is spot-on on the $5 thing.
* She might be ALMOST right! But she seems to be applying the price for 90 days ($190) to a 30-day prescription. Worst case, we'll pay $190 for each Rx, but that will be a three-month supply of each, which works out to $63/month, instead of $95/month, per drug.
Mr. Sue may LOOK LIKE a cheap date, but looks can deceive.