canyonwalker | It Gets Worse - One Prescription is $2,000; Alternative is MORE (Reply)

Last week I wrote about a prescription medicine that used to be free now costing me $2,000/year after my employer switched health care plans. Since then I've explored a few alternatives. Unfortunately the news gets worse.

I met with my doctor and explained the situation. I asked to switch back to a different drug I took a few years ago that worked fine for me and should be much cheaper. She doesn't like to prescribe that drug because it's older, and newer drugs to treat the condition have better overall results. She proposed, and I agreed, to try one of the new drugs to see if my insurance covers it for less than $2,000/year. It doesn't. In fact insurance doesn't cover the newer drug at all, so the cost will be over $4,000/year out of pocket.

While that drug is the most expensive of the few I take, the others are also not free on the new plan. They're about $600/year together. So my out-of-pocket cost has increased $2,600/year on prescriptions alone.

Meanwhile, I'm finding that the $2,000 drug is more important to my health than I thought. A week ago I thought it was doing little for me. Well, several days later I found that after being totally off of it for a while some of my indicators climbed noticeably. So I can't just replace this expensive drug with nothing; I have to find something. Something that is reasonably priced.

I had a conversation with the HR specialist at my company who oversees benefits. Mostly what she's offered is a referral to a "health insurance advocate", a person who will help me understand the benefits of my insurance plan and clear up misunderstandings. These advocates also fight ("advocate") on behalf of the insured when the insurance company is giving them a runaround. But here's the thing— I don't think the insurer is giving me a runaround, I think this is just the reality of the plan my company chose to offer. So the advocate won't change anything. And BTW it's a sign of how much of a mess health care coverage in the US is that it's considered a benefit for employers to provide access to a person who'll argue with the insurance company on your behalf when they're screwing you over.

At the moment I'm still waiting to hear back from my doctor about finding yet-another alternative medication. I reached out to them on their oh-so-convenient smartphone app Thursday night. As of this evening I haven't heard back.