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The shocking cost of drugs

September 13th, 2017 at 04:01 pm

Because the job I've just accepted is a contract job, I find myself once again in the position of having to weigh health insurance costs without the usual employer subsidies.

Having MS, the drug costs are especially frightening.

I researched the 7 plans available to me in my state on the healthcare exchange website. Several insurers have pulled out and there are only 2 left. Of these, I looked most closely at the one with the lowest annual deductible of $1,000. The other plans had deductibles of $2,000, $3,000 and up. (I mean, if your deductible is that high, it just results in your not wanting to get ANY kind of healthcare becus you'll be paying 100% of costs. So what good is that?)

Based on a fairly low 2017 income I roughly calculated for this year at about $43,000 tops, I would get the maximum subsidies available, so my monthly premium for this particular plan would be $362, or $163 less than what I'm paying for health insurance now through COBRA. So far, so good.

But then we get into the weeds of "specialty drug" coverage of the Copaxone I take for my MS. I called the health insurance company, ConnectiCare, and asked them what the retail price of this drug would be for me and she said I'd have to call the pharmacy, Accredo. Accredo said they couldn't tell me the retail price of any drug under any plan except the one I'm enrolled in, so I asked her for that just to have a ballpark number to play with.

The plan I'm looking at would require me to pay 50% of the drug cost up to a maximum of $500 a month. However, the drug company that makes Copaxone has a co-pay assistance program for those who need it. They pay up to $2500 a month, up to a maximum of $12,000 annually.

So Accredo told me under my current Cigna plan (not the one I would need to switch to) the Copaxone I take costs $5,283 a month. This is really shocking to me. About 10 years ago, the cost was around $2500.

So half of $5,283 is $2,641 a month ($31,692 a year), which would be my responsibility. Applying the maximum amount of $12,000 the drug maker would chip in, I would still have to pony up $19,692 a year, or $1,641 a month for just this one drug.

This is what the cost looks like with a not very good plan on the healthcare exchange. Employer-sponsored plans are still the gold standard and far superior to anything else. By way of comparison, thru my COBRA Cigna plan with my old employer, I have $0 copays for the drug. I am glad I chose to stick with this plan even tho my monthly premiums seemed a little high.

I'm not sure what to do about this. I don't think I could bring myself to spend nearly $20K on this one drug. All I can do is keep looking for a new job even as I start this contract job, and also do as good a job as I can to optimize my chance of getting a perm offer there.

I have about 6 months of the Copaxone stockpiled for just this kind of situation. So again, worst case scenario, I enroll in the crappy healthcare exchange plan but at least I could avoid having to pay $2,641 a month for 6 months and use my stockpiled meds, buying me more time to change my circumstances.

In some ways, getting this contract job creates more challenges than it solves. Of course it's more money than I'm getting now thru unemployment, but you know, even if they gave me a perm position with benefits, they are a very small company. I'm not sure how good their regular health plan is, to be honest.

Looking at the longer term picture here, I have 7 more years to deal with this kind of garbage until I turn 65 and can get on Medicare.

Aside from high drug costs, the plan seemed okay, although my neurologist (the one I can't see now because his office and my Cigna insurance couldn't agree on a contract) is now out of network, as well as my gynecologist. My primary care doc and ophthalmologist are in network.

10 Responses to “The shocking cost of drugs”

  1. ceejay74 Says:

    Wow, those are some terrifying numbers. But did you say one plan you were looking at would have you pay a maximum of $500 per month? Compared with $2500 per month, that seems like the clear choice!

  2. PatientSaver Says:

    Ceejay, you're right!!!

    With all these numbers, I forgot to apply the "maximum of $500 a month" the healthcare insurer specified. So instead of $19,692 a year, my max out of pocket would be $6,000, or $500 a month, and then the drug maker would pick up that entire amount.

    MEMBER Pays:

    50% Coinsurance up to $500 maximum per
    prescription after INET plan deductible is met

    !!!!!!

  3. Dido Says:

    Yes, have to pay attention to the OOPs! (out-of-pocket maximum amount).

    Glad to hear you have a contract job and some more income expected in the short term.

  4. My English Castle Says:

    Isn't it useful to have other people to bounce this stuff off?!

  5. LuckyRobin Says:

    This is why people stop taking their medications. The costs can bankrupt you. How much longer can you stay with your COBRA?

  6. PatientSaver Says:

    Yes, English Castle, i have tapped this group's combined intelligence many times.

    Lucky Robin, I can stay with the COBRA til sometime in January.

  7. rob62521 Says:

    Yikes, those are scary numbers indeed!

  8. LivingAlmostLarge Says:

    This is why people don't take medication and go bankrupt. Cancer does the same thing for costs. People don't want to discuss that we already have death panels in the US. it's just not a company. It's people not affording care.

  9. disneysteve Says:

    Did you research the drug cost for the plans with the higher deductibles? Those plans may have better coverage so it migh be worth paying an extra $1,000 or $2,000 in deductible if it saves you thousands in drug costs. The plan with the higher deductible may also have a lower premium so you'd make up some savings there.

  10. Karwoman Says:

    Regarding medications, check out:

    Helprx
    Lowestmed
    Goodrx
    Blink


    The last 2 are particularly great for savings.

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