I received a large long letter from my plan D (the prescription drug plan) listing all the medications I take that the company has changed its' reimbursement plan on. There are three drugs, that I have been on for a while, that are being changed.
One is a medication for allergies and sinuses. Yes it is now out over the counter in just about the same strength. However, since it does not come in boxes of 30 pills for a month, choosing to switch to the OTC will cost me more in never reimbursed/not deductible costs.
Two other medications are not out in generic form yet, but the plan is concerned about the amount of serious, habit forming pain medications that doctors in these plans are handing out. So instead of my having a co-pay of 20% of the monthly payment (until I hit the donut hole... See below) I will be required to pay 68% of the cost of these two prescriptions.
I mentioned the donut hole back there, it costs more than enough problems of it's own. I'll try to explain.
Each year my prescription drug plan limits itself to paying 2000 dollars for my prescriptions. This included my co-pay (the 20 to 68% mentioned above). When my prescription costs hit 2,000 I am then required to pay the next 4,000 out of pocket. It takes me about 5 months to do that. Once that happens, I get for the rest of the year to pay 20% co-pay for the cost of non generic drugs, and between 6 and 12 dollars for generic drugs. Depending on where I might be at the end of the year.
Or if my insurance company decided during the calender year to challenge any prescription my doctors put me on. If they challenge and loose, they don't have to reimburse me. Some times they challenge a new medication for lack of proof it will work with my condition, others just for cost.
I have a question for each of my readers.
If you had to take 600 dollars a month out of your income to pay for a unexpected bill. Would you be able to? Or are you living to close to the edge to ever get sick.
Lets not talk about what I owe two hospitals, and the fights I am having with medicaid plan B to cover a doctors visit. I was told, really TOLD, I went to see a doctor that was to GOOD. And should have gone to a cheaper doctor for a second opinion. Because this guy is so expensive, they want to only pay what a lower tier, lower quality doctor would have charged.
Hum,,, is it any wonder doctors don't want to take on patients who have public health care.