Diabetes drugs being eliminated until deductible met? (HSA, medical, plan)

[Jordy920]

We just found out this week that are diabetes drugs are no longer going to be covered under our prescription plan until our deductible is met. Our deductible is $3000, person, $6000 family. when the first person meets the 3k, they are covered at 100 percent for the rest of the year, other family members are covered at 80 percent up till 6k, then at 100 percent. We always had coverage for these drugs, with a co pay. We were told diabetes drugs, supplies, and asthma medicines will all be out of pocket till the deductible is met. I was just wondering if this is becoming more common place, and would love to hear other people's experience with this.

[mary54mi]

Health Reform Implementation Timeline | The Henry J. Kaiser Family Foundation

All I can mange to find that is not controlled by ACA. Know private insurance rates skyrocketing! He wants us all to suffer the same whether ill or working. He's a communist after all.

[sskkc]

This is NOT typical. Is this insurance through an employer? If so, let the HR know right away - though they should have known this already. I'm shocked with the asthma meds more than the diabetes. I've had health care through employers for 20 years and although there used to be waiting periods for "pre existing" conditions, my asthma care NEVER had a waiting period

[mary54mi]

Health Care Reform Resource Page

[Briolat21]

Originally Posted by Jordy920

We just found out this week that are diabetes drugs are no longer going to be covered under our prescription plan until our deductible is met. Our deductible is $3000, person, $6000 family. when the first person meets the 3k, they are covered at 100 percent for the rest of the year, other family members are covered at 80 percent up till 6k, then at 100 percent. We always had coverage for these drugs, with a co pay. We were told diabetes drugs, supplies, and asthma medicines will all be out of pocket till the deductible is met. I was just wondering if this is becoming more common place, and would love to hear other people's experience with this.

My employer-sponsored insurance is similar to this for medical appointments/procedures -- I pay the full "approvd" cost of the appointment, until I meet the deductible, at which point I have a copay, until the family max is met, at which point I would pay nothing.

My Rx plan is somewhat similar.

But, the insured price of the drug is usually considerably cheaper than non-insured.

For most diabetes medicines - unless its a new mechanism - they are probably generic and should be available for very reasonable costs. (My dad's generic amaryl costs $4). If its a brand new drug (no generic), then it could be considerably more.

Paying full cost (at the insurance companies' price) until a deductible is met is becoming more common, rather than the prior HMO "copay" type plans. Some employer still offer both. If this is through the ACA (not an employer) then you may want to check to see if there are other plans in your area available for next year.

[Jordy920]

It is with an employer sponsored plan, hubby has been with the company 32 plus years, HR alreDy knows about it, as they are the ones that sent the paperwork out telling us To be aware of this change coming, and to make sure we "pad"our health savings account accordingly. He takes two type of insulin and three different pills, The Levimere alone costs $736 for a three month supply alone.

[Jordy920]

Express Scripts is the prescription company.

[Hemlock140]

Actually, this is the trend. The same happened to my sister who is on the subsidized ACA, who loved it until she picked up her insulin. The plan requires that drugs for prevention are covered 100%, no deductible. Diabetes drugs are considered treatment. The same goes for my blood pressure medication (employer paid plan) but fortunately a 30 day supply is only $3 and change.
One might argue that diabetic medication (and heart) are preventing death,
but the ACA has only specific medications listed, the rest you have to pay for.

[Jordy920]

from what I understand all diabetes drugs will not be covered, whether brand or generic until the $3000 deductible is met. He just started taking the insulin two months ago, and his blood work is really starting to look good.

[Briolat21]

Originally Posted by Jordy920

It is with an employer sponsored plan, hubby has been with the company 32 plus years, HR alreDy knows about it, as they are the ones that sent the paperwork out telling us To be aware of this change coming, and to make sure we "pad"our health savings account accordingly. He takes two type of insulin and three different pills, The Levimere alone costs $736 for a three month supply alone.

So is this essentially a Health Care Savings Account plan (High Deductible, allows contribution to an HSA?)?

Because it sounds like it.

In which case, you put money into the HSA (pretax) to cover your expenses up to the deductible. (Or as much as you want up to the yearly limit).

while the Insulin your husband is taking isn't "covered" - you are likely getting it at the insurance company's negotiated rate, rather than paying the "full price" that the uninsured would pay.

You may want to find out from your husband's doctor if any of the older drugs (which have generic / cheaper equivalents) would be a possibility, but if your doctor feels this drug is the best one for your husband, then you'll want to adjust your witholding for next year's HSA contribution.