Hey Forum Members,
The company I work for is going to switch to Blue Cross Blue Shield (Anthem) health insurance. I'm trying to understand the impact of my out-of-pocket insurance limit with one of the plans since that one plan does not include "prescription drugs" in the out-of-pocket limit calculation.
Are drugs like dex and Revlimid considered to be "prescription drugs" by Blue Cross Blue Shield or are they treated separately as chemo by Blue Cross Blue Shield? Can I assume that IV-delivered drugs like Velcade are not considered to be prescription drugs?
I understand the huge cost issue with this Rx-versus-IV problem for many cancer patients, but I am not clear if I am risk with this particular carrier. http://kaiserhealthnews.org/news/oral-chemotherapy.
Does anybody have any multiple myeloma treatment experience with this particular carrier (good, bad or otherwise)?
Forums
3 posts
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Basic Questions on Chemo versus Rx Coverage
Multibilly-
Both dex and Revlimid are prescription drugs. The dex should have a minimum copayment in any plan that you get. Revlimid is a tier 5 drug, specialty drug, that will require prior authorization for prescription and will have a higher copay.
I would suggest that you call both insurance companies and ask specific questions about their prescription coverage and what your costs will be. When I was still working, my Blue Cross plan had a $10 copay for most drugs and a $25 copay for Revlimid. How I yearn for those days again. I think that I actually paid the cost of the dex prescription because it was lower than $10.
Talk to the representatives of both companies. Each employee plan is a little different from one another, so you want specifics related to your employer.
Good luck getting the information you need to make an informed choice. Choosing the best insurance plan for your situation is almost as hard as choosing the appropriate treatment for your cancer.
Nancy in Phila
Both dex and Revlimid are prescription drugs. The dex should have a minimum copayment in any plan that you get. Revlimid is a tier 5 drug, specialty drug, that will require prior authorization for prescription and will have a higher copay.
I would suggest that you call both insurance companies and ask specific questions about their prescription coverage and what your costs will be. When I was still working, my Blue Cross plan had a $10 copay for most drugs and a $25 copay for Revlimid. How I yearn for those days again. I think that I actually paid the cost of the dex prescription because it was lower than $10.
Talk to the representatives of both companies. Each employee plan is a little different from one another, so you want specifics related to your employer.
Good luck getting the information you need to make an informed choice. Choosing the best insurance plan for your situation is almost as hard as choosing the appropriate treatment for your cancer.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Basic Questions on Chemo versus Rx Coverage
I'm not sure if this helps much as we have a different insurance carrier, but the formularies seem close across the plans.
We have prescription copays for Revlimid and the other oral medications, all are Tier 1 or 2 drugs for us. The Velcade infusions, however, are not covered under the prescription coverage and we are responsible for 10% of the cost of any drugs "administered in the office."
We had trouble getting a firm answer from the insurance company, especially before we had a plan and were investigating our options. I would say to just be persistent and try to talk to more than one rep if possible. Even paying just 10% of the cost is adding up quickly.
We have prescription copays for Revlimid and the other oral medications, all are Tier 1 or 2 drugs for us. The Velcade infusions, however, are not covered under the prescription coverage and we are responsible for 10% of the cost of any drugs "administered in the office."
We had trouble getting a firm answer from the insurance company, especially before we had a plan and were investigating our options. I would say to just be persistent and try to talk to more than one rep if possible. Even paying just 10% of the cost is adding up quickly.
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VanessaR - Name: Vanessa R
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: November 2016
- Age at diagnosis: 49
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