Re: NEWS: Co-payments for expensive drugs soar

Insurance companies have been doing this a while.

In our company and the one we had before, there is what is called a
"formulary." It's a list of drugs the insurance company gets a deal
on for one reason or another. We pay a percentage of the cost of the
formulary drugs we are prescribed. It is basically up to us to make
sure the drugs we are prescribed are on our formulary if we want to
keep the costs down.

1. Generic formulary drugs are cheapest.

2. Brand name formulary drugs are still covered, but they cost more
because the retail price is higher.

3. Non-formulary generic drugs are mostly covered but they are paid
out at a flat rate so the copay is, I think at this point, $5 or $10.
Sometimes the ChinaMart list has them cheaper, though even this year
they went up to $5 instead of $4.

4. Non-formulary brand name drugs....well shucks, you're on your own,
baby. These include drugs like Provigil that are prescribed for
indications not covered by the FDA approval schedule. If it was
covered, it would cost me about $25 a month. On my own? Over $300.
Hence the screwed up sleep schedule. I got 4.5 hours of uninterrupted
sleep last night with the assistance of 2 e.s.tylenol and 30mg of
restoril. It's the most I've had in weeks at one shot. I can't get
the Provigil, though, because I don't have the specific sleep
disorders it's FDA-approved for. I'm in the midst of an appeal.
We'll see how that comes out.

People have to start getting smart and knowing which drugs are covered
by their insurance, and if they don't have insurance, they need to
carry the Walgreens list or the ChinaMart list with them and insist
the prescribing doc uses a med from that list if one in the class they
need is on there.

Funny thing is, antiseizure drugs aren't on either list...aren't those
as essential as an antibiotic? Dilantin isn't any more expensive than
Amoxicillin....it would be nice if they'd have a few of those kinds of
drugs on there, too.

Trisha, still too tired to make much sense

.

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