Hello! I'm wondering if others are finding new challenges with insurance and co-pay assistance since 2023 began. I've been on Humira for the last two years (I was previously on Cosentyx and Remicade before that). Things were smooth the first year after initial hiccups. As with Cosentyx, the co-pay assistance was helping with my ridiculous deductible, which a blessing for which I was grateful. Last year, the insurance company stopped counting co-pay assistance toward my deductible. I read up and found this was a lobbied-for legal change. Apparently they even riled up employers making purchasing decisions that people like us were getting unfair benefits and needed to have some "skin in the game" (like our skin and organs aren't already in the game, right?).
I was able to get around this by paying cash that was reimbursed by the drug company. This year the insurance company has created a new program to "help." As soon as they started calling me about it around the clock I knew it was a new way to control my co-pay assistance. I called the drug company to see what they knew. After a nearly 2 hour phone call involving the drug company and many different departments at insurance, I learned that now the insurance will empty the annual allowance from the drug company, then their program will assume the cost. This is a massive win for the insurance company which will now be getting about 12,000 extra a year from the drug company while I also have to pay for all of my other medical care out of pocket. I won't pay for meds, but I'll still be on the hook for my 5000 deductible/7000 out of pocket maximum, which I will meet as I do every year. I was frustrated, but I ordered my meds.
This week I received a bill for $800 from the pharmacy. I called and was told the drug company said my benefits were maximized. I was bounced around through three people until I got someone that explained that the drug company is now zeroing out co-pay accounts if patients sign up for plans through insurance! The drug company rep I was on the phone with forever last month had no idea and told me I should do the insurance program when I was skeptical. Now the insurance companies and drug companies are now at war over who is paying for these insanely overpriced meds, and I''m stuck in the middle. I have to call the drug company back and try to figure it out (while trying to work and do everything else). I'm just exhausted.
Sorry for the novel. I'm curious if you all are going through the same, and if anyone has mastered the situation.