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Prescription costs and coverage

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  • Prescription costs and coverage

    I was wondering if anyone knows how the pricing works for prescriptions when you have insurance. I had a PPO and until last year I had no problems. Then they decided Elmiron (which I have been taking for 20 years) now needed a pre authorization. Fine. My Dr. had no problem with that. Then they decided they were no longer going to cover Uribel and similar meds. For a plan that I was paying $1500/month for I don't think they should be reducing coverage. My PPO was going to jump from $1500/month to $2100/month. So much for the Affordable Care Act. So I switched to an HMO that is a little less than $1000/month. I don't qualify for a subsidy. January will be the first month of meds with my new insurance. Of the 6 I take for my bladder only 2 are Tier 1 = $4 generics. The rest are tier 2 so they pay 50%. Hopefully someone can explain the breakdown for me. This is for Hydroxyzine. A generic bladder med. Still under the old insurance.

    Amount $19.28
    You Pay $5.00 (my copay)
    Ins Pays $14.28
    U/C $19.28

    So is the total $38.56 but the insurance company gets 1/2 off? Then we each pay our percentage of the remainder?? How is $19.28 uncollected if that is the total amount? And if with my new plan we each pay 50% is that the amount or the amount plus uncollected??? I consider myself a fairly smart person but I can't figure this out at all. Health insurance should not be this complicated.

  • #2
    Re: Prescription costs and coverage

    Their formulas are so complicated that I haven't been able to figure it out. Your pharmacist might be able to answer your questions?

    Donna
    Stay safe


    Elmiron Eye Disease Information Center - https://www.ic-network.com/elmiron-p...mation-center/
    Elmiron Eye Disease Fact Sheet (Downloadable) - https://www.ic-network.com/wp-conten...nFactSheet.pdf

    Have you checked the ICN Shop?
    Click on ICN Shop at the top of this page. You'll find Bladder Builder and Bladder Rest, both of which we are finding have excellent results.

    Patient Help: http://www.ic-network.com/patientlinks.html

    Sub-types https://www.ic-network.com/five-pote...markably-well/

    Diet list: https://www.ic-network.com/interstitial-cystitis-diet/

    AUA Guidelines: https://www.ic-network.com/aua-guide...tial-cystitis/

    I am not a medical authority nor do I offer medical advice. In all cases, I strongly encourage you to discuss your medical treatment with your personal medical care provider. Only they can, and should, give medical recommendations to you.
    [3MG]

    Anyone who says something is foolproof hasn't met a determined fool

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    • #3
      Re: Prescription costs and coverage

      I'm sure you're right. I always ask him a lot of questions about new meds or whatever. I didn't want to bother him with this but he might be the only one that can help. Why can't they make it easy????



      Originally posted by ICNDonna View Post
      Their formulas are so complicated that I haven't been able to figure it out. Your pharmacist might be able to answer your questions?

      Donna

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