Pharmacy Deductible ?

g8orell

Are there any insurance brokers, pharmacists or anyone who knows about pharmacy deductibles out there? It's cheaper to take my family off of my employer's insurance onto their own plan with BCBS and I see they have a pharmacy deductible of $1500. Does that mean that we have to pay $1500 out of pocket before they will cover a medication?? Like if  DD needs amoxicillin, which is like $15, I have to pay $1500?? Thanks!

susanlovestexas

You would have to pay the full retail price of prescriptions until you've reached $1500 out of pocket.  Like if you needed amoxicillian, you'd have to pay whatever the price of it is at the pharmacy.  You could get the generic, but I think even that would be more than $15.  I didn't have insurance for a bit and paid all Rx's out of pocket.  Most are pretty expensive.

realisticdreams

g8orell:

Are there any insurance brokers, pharmacists or anyone who knows about pharmacy deductibles out there? It's cheaper to take my family off of my employer's insurance onto their own plan with BCBS and I see they have a pharmacy deductible of $1500. Does that mean that we have to pay $1500 out of pocket before they will cover a medication?? Like if  DD needs amoxicillin, which is like $15, I have to pay $1500?? Thanks!

That's an insane pharmacy deductible.  Most group plans (that do have deductibles) are no more than $150.  I just re-read that it is an individual plan though, so it's not uncommon that non-group plans have crappy crappy rx coverage.  

If the term is "1500 pharmacy deductible" then yes, that is what you have to pay BEFORE it kicks in.  If it says, "out of pocket" then that is the most you would pay out of pocket.  I freaked because dh's insurance for rx said "3000 out of pocket max." and it wasn't until a week later I re-read it and realized it meant we would pay no more than that out of pocket for rx meds.

To give you some perspective, (these are CVS prices-i've worked there for 9 years in the pharmacy)

My lovenox for a box of 10 syringes is $1500 without insurance.

A 100ml bottle of amox 400/5ml is under $25ish.

a 100ml bottle of generic omnicef is probably around $60

a zpak is in the $40 range. 

prescription drugs are pretty expensive, now places like walmart have good deals and CVS does too if you are getting 90 day supplies, but you never know when you will need something crazy.

 

g8orell

realisticdreams:

g8orell:

Are there any insurance brokers, pharmacists or anyone who knows about pharmacy deductibles out there? It's cheaper to take my family off of my employer's insurance onto their own plan with BCBS and I see they have a pharmacy deductible of $1500. Does that mean that we have to pay $1500 out of pocket before they will cover a medication?? Like if  DD needs amoxicillin, which is like $15, I have to pay $1500?? Thanks!

That's an insane pharmacy deductible.  Most group plans (that do have deductibles) are no more than $150.  I just re-read that it is an individual plan though, so it's not uncommon that non-group plans have crappy crappy rx coverage.  

If the term is "1500 pharmacy deductible" then yes, that is what you have to pay BEFORE it kicks in.  If it says, "out of pocket" then that is the most you would pay out of pocket.  I freaked because dh's insurance for rx said "3000 out of pocket max." and it wasn't until a week later I re-read it and realized it meant we would pay no more than that out of pocket for rx meds.

To give you some perspective, (these are CVS prices-i've worked there for 9 years in the pharmacy)

My lovenox for a box of 10 syringes is $1500 without insurance.

A 100ml bottle of amox 400/5ml is under $25ish.

a 100ml bottle of generic omnicef is probably around $60

a zpak is in the $40 range. 

prescription drugs are pretty expensive, now places like walmart have good deals and CVS does too if you are getting 90 day supplies, but you never know when you will need something crazy.

 

Thanks! I've applied to both BCBS and that's what has the $1500 pharm deductible. We also applied to Cigna (we got accepted to both, but I have 10 days to cancel one)...Cigna is a $250 pharm deductible which is MUCH more reasonable, but I have to pay a coinsurance for labs (80/20) whereas with BCBS it's free as long as we go to Quest. I know labs can be pretty insance too, but I think we are much more likely to have meds (especially with 2 kids in daycare) vs labs. And DD sometimes uses Xopenex and Pulmicort which are pretty expensive!

g8orell

OK, I just went back and read that pharm deductible applies to brand and non-preferred drugs only. So generics would be okay. Ughhh, this is so hard! I'm fine with generics, but I'm a derm PA and I know that a lot of the stuff we prescribe in derm, the brand is WAY better than the generic b/c of vehicles, etc.

jrlandrigan

g8orell:

realisticdreams:

g8orell:

Are there any insurance brokers, pharmacists or anyone who knows about pharmacy deductibles out there? It's cheaper to take my family off of my employer's insurance onto their own plan with BCBS and I see they have a pharmacy deductible of $1500. Does that mean that we have to pay $1500 out of pocket before they will cover a medication?? Like if  DD needs amoxicillin, which is like $15, I have to pay $1500?? Thanks!

That's an insane pharmacy deductible.  Most group plans (that do have deductibles) are no more than $150.  I just re-read that it is an individual plan though, so it's not uncommon that non-group plans have crappy crappy rx coverage.  

If the term is "1500 pharmacy deductible" then yes, that is what you have to pay BEFORE it kicks in.  If it says, "out of pocket" then that is the most you would pay out of pocket.  I freaked because dh's insurance for rx said "3000 out of pocket max." and it wasn't until a week later I re-read it and realized it meant we would pay no more than that out of pocket for rx meds.

To give you some perspective, (these are CVS prices-i've worked there for 9 years in the pharmacy)

My lovenox for a box of 10 syringes is $1500 without insurance.

A 100ml bottle of amox 400/5ml is under $25ish.

a 100ml bottle of generic omnicef is probably around $60

a zpak is in the $40 range. 

prescription drugs are pretty expensive, now places like walmart have good deals and CVS does too if you are getting 90 day supplies, but you never know when you will need something crazy.

 

Thanks! I've applied to both BCBS and that's what has the $1500 pharm deductible. We also applied to Cigna (we got accepted to both, but I have 10 days to cancel one)...Cigna is a $250 pharm deductible which is MUCH more reasonable, but I have to pay a coinsurance for labs (80/20) whereas with BCBS it's free as long as we go to Quest. I know labs can be pretty insance too, but I think we are much more likely to have meds (especially with 2 kids in daycare) vs labs. And DD sometimes uses Xopenex and Pulmicort which are pretty expensive!

If I were you, I'd go with Cigna. Paying way less for rx and only 20% of labs is way better than paying out of pocket for all rx. I work in a medical office so I know a good deal about ins, but not as much about the rx part. I have a high deductible plan though through Anthem (through work) and we just had to get an Epipen for K and it cost $156 since we have to pay full price since we only met the deductible when I was pregant.. it's not just for rx though, everything goes towards our deductible.