I'm 57 and have employer insurance. I've been using Blue Cross for years, but it has a $6500 medical max out of pocket plus a 20% copay on prescriptions. The max copay for prescriptions is $250 per script with no max out of pocket.
As most of you know, Revlimid is a typical maintenance drug with a very high cost and a script that must get written every 28 days. This results in me getting charged $250 per month for Revlimid, plus the other six pills they have me taking.
I've been considering switching to a Kaiser plan that my employer has available that has a lower cost monthly premium. But, I'm not sure how Kaiser handles the prescriptions.
Is the max out of pocket referenced in the Kaiser plans inclusive of prescriptions?
All my cohorts on Kaiser love it and never pay anything for scripts, but then again, they aren't buying chemo drugs either.
Jerry.
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JBarnes - Name: Jerry Barnes
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: Aug 17, 2012
- Age at diagnosis: 54
Re: Kaiser coverage of myeloma-related prescriptions?
Hi Jerry,
I don't know any specific information about Kaiser. And like you, we have Blue Cross (thru my employer) and my husband's Revlimid prescription copays are not applied to our out of pocket max, so we also pay them no matter how high it gets.
However, I found it very interesting that, when perusing Blue Cross plans on the Health Insurance Exchange, prescriptions WERE applied to the out of pocket max on some plans.
So, If it were me, I'd call the Kaiser folks and ask them directly. They should also be able to send you an overview of the plan's benefits, detailing the company's out of pocket max and if prescription drugs are included in the out of pocket max. Kaiser should also be able to give you a copy of the current drug formulary which would indicate if it covers Revlimid and the copay amount. In our BCBS plan, Revlimid is considered a "specialty drug" and the copay is much higher than other drugs prescribed more commonly.
We're trying to decide when we can retire ( ages 62 and 59) but since we won't be eligible for Medicare for a few years, we've been crunching the numbers, too...
Good luck and best wishes,
Chris M.
I don't know any specific information about Kaiser. And like you, we have Blue Cross (thru my employer) and my husband's Revlimid prescription copays are not applied to our out of pocket max, so we also pay them no matter how high it gets.
However, I found it very interesting that, when perusing Blue Cross plans on the Health Insurance Exchange, prescriptions WERE applied to the out of pocket max on some plans.
So, If it were me, I'd call the Kaiser folks and ask them directly. They should also be able to send you an overview of the plan's benefits, detailing the company's out of pocket max and if prescription drugs are included in the out of pocket max. Kaiser should also be able to give you a copy of the current drug formulary which would indicate if it covers Revlimid and the copay amount. In our BCBS plan, Revlimid is considered a "specialty drug" and the copay is much higher than other drugs prescribed more commonly.
We're trying to decide when we can retire ( ages 62 and 59) but since we won't be eligible for Medicare for a few years, we've been crunching the numbers, too...
Good luck and best wishes,
Chris M.
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Chris M.
Re: Kaiser coverage of myeloma-related prescriptions?
Thanks for the update. I'll have to see what plans get announced in October. Thought I might get some idea of Kaiser plans from actual users.
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JBarnes - Name: Jerry Barnes
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: Aug 17, 2012
- Age at diagnosis: 54
Re: Kaiser coverage of myeloma-related prescriptions?
From what others occasionally post about their experience with Kaiser, you need to find out if your oncologist is in the Kaiser network. If not, you will have to change specialists and one may not be as convenient in location as your current one. Not an obstacle that should deter you from changing insurance, but a consideration.
So many things to consider in dealing with this diagnosis. As if the disease isn't confusing enough, but we have to deal with very confusing insurance issues, too.
Good luck finding out what you need from the insurance companies,
Nancy in Phila
So many things to consider in dealing with this diagnosis. As if the disease isn't confusing enough, but we have to deal with very confusing insurance issues, too.
Good luck finding out what you need from the insurance companies,
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
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