I’m not in the habit of wishing bad things to happen to anybody, but yesterday, when I was at the pharmacy counter, I was wishing every member of Congress would have to experience the same insanity I was experiencing. If they did, they just might do something to fix the growing crisis they helped create when they passed the so-called “Medicare Modernization Act” (MMA) in 2003.
Out of pocket thru Canada….THREE Serevent Diskus (salmeterol xinafoate) from Canada via Mauritius scheduled to arrive including shipping: $67.99. Generic Ventolin: THREE inhalers @ $56.74 inclusive shipping right from Vancouver, BC. Thank you 🇨🇦! I’m an old hand at this now. If you’re picking up inhalers in the US you’re overpaying.
1) Was the initial Symbicort filled at a CVS rather than a Rite Aid?
2) Was your 3 month supply of symbicort going to be $606 at refill, or did you not check?
I ask because $606 is $480 + $126 - you met your $480 deductible on that fill and then you paid the Wellcare "preferred pharmacy" copay of $126 for 3 months for a tier 3 branded medication (in a single transaction of $606, but still). CVS is a preferred pharmacy in Wellcare's network, Rite Aid is a standard pharmacy, resulting in an out of pocket cost difference of $5/month ($15/3 months).
I suspect that your symbicort would be $126 at refill time, not $606.
Also, had you not filled the symbicort earlier in the plan year, your Wixela would have been $621, not $141, because you wouldn't have met the $480 deductible yet.
Is this insanely complicated and stupid? Yes.
Today at the pharmacy, I was discussing options with a patient who had Wellcare Part D coverage. Based on the low acquisition costs of the 4 medications he was taking, I suspected that all 4 drugs would be tier 1 (at most 2) on his plan's formulary. To my surprise, one was tier 1, two were tier 2 and the fourth was tier 3. This meant that his copays, rather than being the expected $10/month for each, were in fact $10/month, $20/month, $20/month and $47/month (after meeting a $480 deductible). So the total copayments per month added up to $97/month, not $40-50 that I expected to see.
I'm so glad to see this post. I recently had a very similar experience. CVS in San Francisco informed me by automated call that Wixela would provide a generic alternative to my Advair. After confusing exchanges with CVS and my doctor, I learned that Wixela was not covered by my SilverScript Choice/Aetna Part D Plan, so I stayed with the Advair brand name. I've already paid most $900 for this year's "deductible." Meanwhile, I've seen my monthly "premium" jump by 50% in the past 5 years.
I wish it happened to them all the time. The only experience with the American healthcare system they created is how it feels to lose/gain lobbying money from the pharma/insurance cartel that straight-up writes the legislation. They write it and members of Congress insert it. And somehow they always seem to have the healthcare plans that the rest of us say we would like, but they tell us would not be possible in the marketplace.
Out of pocket thru Canada….THREE Serevent Diskus (salmeterol xinafoate) from Canada via Mauritius scheduled to arrive including shipping: $67.99. Generic Ventolin: THREE inhalers @ $56.74 inclusive shipping right from Vancouver, BC. Thank you 🇨🇦! I’m an old hand at this now. If you’re picking up inhalers in the US you’re overpaying.
A few questions:
1) Was the initial Symbicort filled at a CVS rather than a Rite Aid?
2) Was your 3 month supply of symbicort going to be $606 at refill, or did you not check?
I ask because $606 is $480 + $126 - you met your $480 deductible on that fill and then you paid the Wellcare "preferred pharmacy" copay of $126 for 3 months for a tier 3 branded medication (in a single transaction of $606, but still). CVS is a preferred pharmacy in Wellcare's network, Rite Aid is a standard pharmacy, resulting in an out of pocket cost difference of $5/month ($15/3 months).
I suspect that your symbicort would be $126 at refill time, not $606.
Also, had you not filled the symbicort earlier in the plan year, your Wixela would have been $621, not $141, because you wouldn't have met the $480 deductible yet.
Is this insanely complicated and stupid? Yes.
Today at the pharmacy, I was discussing options with a patient who had Wellcare Part D coverage. Based on the low acquisition costs of the 4 medications he was taking, I suspected that all 4 drugs would be tier 1 (at most 2) on his plan's formulary. To my surprise, one was tier 1, two were tier 2 and the fourth was tier 3. This meant that his copays, rather than being the expected $10/month for each, were in fact $10/month, $20/month, $20/month and $47/month (after meeting a $480 deductible). So the total copayments per month added up to $97/month, not $40-50 that I expected to see.
I'm so glad to see this post. I recently had a very similar experience. CVS in San Francisco informed me by automated call that Wixela would provide a generic alternative to my Advair. After confusing exchanges with CVS and my doctor, I learned that Wixela was not covered by my SilverScript Choice/Aetna Part D Plan, so I stayed with the Advair brand name. I've already paid most $900 for this year's "deductible." Meanwhile, I've seen my monthly "premium" jump by 50% in the past 5 years.
I wish it happened to them all the time. The only experience with the American healthcare system they created is how it feels to lose/gain lobbying money from the pharma/insurance cartel that straight-up writes the legislation. They write it and members of Congress insert it. And somehow they always seem to have the healthcare plans that the rest of us say we would like, but they tell us would not be possible in the marketplace.