[newone]

I can't afford my old helath insirance plan any longer - if I pay the premiums there's no money left to pay my out-of-pocket expenses (drugs, deductible, etc.) Not to mention the premiums are sky high. Does anyone know how HMO's work when it comes to drugs like Copaxone? Are there maximum drug allowances? Thanks for your help!

[Victor H]

Originally Posted by newone

I can't afford my old helath insirance plan any longer - if I pay the premiums there's no money left to pay my out-of-pocket expenses (drugs, deductible, etc.) Not to mention the premiums are sky high. Does anyone know how HMO's work when it comes to drugs like Copaxone? Are there maximum drug allowances? Thanks for your help!

I can tell you who is expensive...Anthem Blue Cross.

Take a look at my post in the Tysabri thread.

I wish you a ton of luck in your search.

-Vic

[kicker]

Before starting any plans, understand what they cover. I get through my husbands job, go to doctor I like (who is one of doctors approved
I like plan, as most doctors are etc.. Got my Rebif for nothing but when getting a power chair, their approved comppamny said 16,000 (Yikes) and found out they only allow 3500!!!! I couldn't pay the other 12,500! We negotiated price down (Removing wheelchair options - did they bother?) and lo and behold it became much lower price I stated I could pay with my 3500 DME (Durable Medical Equipment.)

If think equipment suppliers ask a charge a lot. Be careful out there!

[KarenMarie]

Depends on whether or not you are on Medicare, etc - Copaxone is a Tier 4 injectible - with RX insurance plus medicare you have to pay 1/3 the cost - which is a lot - perhaps you can apply for funding through Copaxone's Shared Solutions - they give your info to the Chronic Disease Fund which then evaluates whether or not you qualify - you might even get it free depending on your circumstances -

[barb02]

My HMO did not charge anything for copaxone. It was considered a treatment, not a med. It all depends on your plan.

[KarenMarie]

Wow - what's your plan - mine is $860 monthly - if I stay with Copaxone - all the Medicare approved supplementary insurances are 1/3 the monthly cost -

[barb02]

Health Alliance -- in Illinois. However, I have actually changed plans, so I can go to whatever doctor I want. I do not need any referrals. My costs are somewhat higher, but I was not happy with choice of pcp's. I am a state employee (university) so we do have decent insurance. I have a colleague who is on this plan (the one I switched to), and he pays 11.00 a month for avonex. I also did not have to pay anything for tysabri when I was on it through the HMO. I may regret switching plans, but I wanted more flexibility.

[KarenMarie]

You are very lucky with your insurance - don't lose it !! Hopefully your retirement program will include your health insurance - no one in their right mind would want to have to consider the co-pay I would have to come up with now that I'm retired - and my decision - is no - not doing it -

[barb02]

Once I have 20 years (this is my 20th), I am entitled to full health care coverage when I retire. They pay the entire premiums when you retire. Of course, the state has been talking about changing this, but I think if they do, there will be a grandfather clause. It will only affect new employees.

I am sorry you cannot find a more affordable plan.

[Kitty]

Most of the big pharmaceuticals have prescription assistance plans for those who cannot afford their meds. You can go to www.pparx.com and get all the info and enter the drugs you are on to see if they have a plan.