Drug copay assistance no longer counts towards deductible. Medica sucks

[Survivor1965]

The title says it all. Found out yesterday that the co-pay assistance I received for my Xtandi will not count towards my health insurance deductible with MEDICA on my COBRA. It a newer concept (late last year??) that the pharmacy benefit managers came up with. I have $25,000 of scans, mri’s, blood work, and dr visits every 4 months (later this month) and now will be in the hook for the entire $6,500 deductible even though the copay assistance paid out about $10,000 on my behalf. They say it will help drive down drug prices but in the end MEDICA is basically double dipping.

It’s disgusting. On one hand I didn’t have to pony up the $6,500 for the meds but a few weeks later I will anyway because of the scans. And the copay assistance pays way more out to the pharmacy because my deductible is not recognized. In my situation it ends up being financial assistance to my insurance company, MEDICA, and not me at all. MEDICA is double dipping, Xtandi gets their high priced drugs paid for, and ultimately is no assistance for me at all.

Something should be done to reverse this.

[pjoshea13]

My wife found herself being assisted a few months ago. Her chemo is $8,000 / month & she gets a call from the supplier each month & has to answer some questions. Afterwards, the amount not covered by insurance is charged to our credit card before being shipped. One month, that amount jumped by over $600. When questioned, the person on the line asked what our Social Security benefits & various pension amounts were. She was not asked about other assets, or to provide proof of any kind, but immediately switched to a program that would take care of payments for the remainder of the year.

I view this simply as a discount designed to keep her using the drug. I don't see why my wife should also get out-of-pocket credit for a discount. I'm just grateful that the supplier was so eager to offer it.

-Patrick

[pjoshea13 in reply to pjoshea13]

Note Darryl's recent post on assistance:

healthunlocked.com/advanced...

[Chask]

I am so grateful for universal Health Care here in Australia.

My monthly prescription for Zytiga has the labelled price of $3,200. I pay $6.20. That is without any private insurance. The Govt pays.

[VHRguy in reply to Chask]

You brought up a political angle, and brag about socialist policy.

To be clear, your fellow citizens are paying, not "the government". You are taking money from your neighbors by proxy, via government force. The government has NO money of its own, only what it can extort from citizens by threat of violence. Yay for you.

[Survivor1965 in reply to VHRguy]

Well thanks for straightening me out on that...

[Hidden in reply to VHRguy]

Yeah, but I'll bet the Australian government can do something out Gov Medicare can't -- negotiate better prices for expensive cancer meds.

[michael00]

Health partners did the same thing with manufacturers copay assistance. Sounds lie many private insurers will be leaning that way soon