Insurance (2021) .....

Hi All:

I just discovered that on top of the 11% premium increase - my current provider is not going to cover Tacrolimus or Prograf.  Frankly, they will but at a higher price than I could buy it without them.  I'd like to spell out the facts:

 

For the two of us (my wife is relatively healthy) ....

* Combined went the to visit a doctor ~ 6 times last year (of those, 2 were dermatologist, semi-unrelated to my kidney transplant)

* Combined lab work ~ 7 times.

* Kidney Meds (lots) and a few ancilary for her.

*  I personally have not seen a DOCTOR for years - only the nurse assistant and she ignores most of what I ask and seldom returns calls with questions.

*  We are both self-employed (Aka  ACA / Obamacare, call it what you want).

*  Paid ~ $15,500 (Premiums) + Various Co-Pays & Montly Bills ~ 1,100 + Rx Co-pays ~ $525 = ~ $17,125  (both of us).

 

I am seriously dropping it and paying (seldom) as I go.  I know most of you will jump on me and say how you'd never do such a thing.  I respect that but please don't say it.  I know that and that is why I am posting here - looking for some alternative / odd-ball means that someone lese might be able to offer as a solution.  The good news is that the others Rx (meds) are still covered for now.  The irony is that this is Oscar Health, co-owned by the Cleveland Clinic Foundation (CCF) forcing me to consider something drastic of going without and hoping for the best.  A bad strategy, but it's so much moeny for less and less.

Has anyone had luck with online presciption?  If so, how do you get a doc script?  Most doc's (I've heard) refrain from writing a script to an online pharmacy (US or Asian).

IF I were to drop it, does anyone have experience with some sort of telemed (to get a Rx or normal review)? 

I possibly might dumb down the coverages (Gold >> Bronze) but all of the math adds back to roughly the same place.  It's a shell game.

 

For the record, I / we can afford this.  It hurts.  Fact is we pay a tremendous amount AND it's at a point of removing the vital coverages for it to be worthwhile.  I would roughly estimate the increase (premium and self-pay of Tacrolimus) to be an additional of ~ $3,000 from above.  This assumes the CCF would actually do something like write a script to an online pharmacy (I doubt it).

Tx-

George

 

 

 

 

 

 

 

 

 

 

 

 

 

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Replies

  • It sounds as if you ahve to bounce around due to availability.  How do you manage the prescriptions?

    Also, does your doctor write the prescriptions to you?  Mine, so far, says they will not write a an prescription to an online pharma & has said on their affiliated insurance that will not cover it but I can buy form them at a higher than market price.  That is my beef.

     

    Thanks for the response.

    • Interesting that a doc would push back on that.

      You can fill a prescription anywhere you wish.  I mostly just deal with the onsite Pharmacists at my clinic.  They send them out generally.  Been a while but the online pharmacy may have contacted the pharmacy I was using and transferred it.

      I had to bounce once to Blink - and they have been great for a year - it just came this month with first interruption.  I can always pay retail if in a jam but tried GoodRx and will let you know what the price comes to - pick it up tomorrow.

      Like I said about $1 a pill.  I have found it for about 68 cents a pill.  Online was about 35-50 cents a pill.  GoodRx said about 30 cents a pill (but have not picked up yet).

  • You do whatever you need to.   I will just stick to mediction segment. My Supplement has never covered Tacro so I have used online pharmacy.

    mailmyprescriptions.com is Ok but they do not have in stock often and ordering challenging.  Blink Pharmacy is really good when they have in stock - great price - about $45 120 1 mg (1 month for me 2mg BID)  And very simple.  But just this month they did not send and didn't notify not in stock.  Just tried Good RX at Fred Meyer pharmacy and if they honor the GoodRX will be about $39.  Hoping that works as GoodRX does not always work.

    About a $1 a pill 1mg retail.

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