Political Discussion

RenegadeMonster said:
Just attended our 2021 benefits info session and heard of something new on Prescription Drug coverage that I have never heard of before as a change to our existing coverage.

Specialty drugs are no longer covered with our prescription plan. We need to enroll in a separate plan for specialty drugs if we are on any, or think we may need them in 2021. Otherwise specialty drugs would be 100% out of pocket expense to us, and would not count towards our deductible / out of pocket maximum on our medical insurance.

There are 153 drugs currently listed on the specialty drug list. Co-pays for the specialty drugs range from $75 to $1,000. A savings plan is available to sign up for covering these co-pays.

I'm not familiar with what the drugs are for, but I would assume most are for cancer or rare diseases or are biologics.

So not only are the Co-pays high, but to have coverage for these drugs it's an additional $20 a month plan I would need to enroll in.

I'm going to pass on enrolling and take my chances as I don't need any speciality drugs, but I don't like the sound of where this is heading.

What happens when more people start having to have plans like these? And those who don't have no coverage when they get cancer? That's not a great thing for our healthcare system.
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My husband's psoriatic arthritis meds won't be covered next year. He's on generics, but it's still ridiculous.
 
RenegadeMonster said:
Just attended our 2021 benefits info session and heard of something new on Prescription Drug coverage that I have never heard of before as a change to our existing coverage.

Specialty drugs are no longer covered with our prescription plan. We need to enroll in a separate plan for specialty drugs if we are on any, or think we may need them in 2021. Otherwise specialty drugs would be 100% out of pocket expense to us, and would not count towards our deductible / out of pocket maximum on our medical insurance.

There are 153 drugs currently listed on the specialty drug list. Co-pays for the specialty drugs range from $75 to $1,000. A savings plan is available to sign up for covering these co-pays.

I'm not familiar with what the drugs are for, but I would assume most are for cancer or rare diseases or are biologics.

So not only are the Co-pays high, but to have coverage for these drugs it's an additional $20 a month plan I would need to enroll in.

I'm going to pass on enrolling and take my chances as I don't need any speciality drugs, but I don't like the sound of where this is heading.

What happens when more people start having to have plans like these? And those who don't have no coverage when they get cancer? That's not a great thing for our healthcare system.
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Seems a lot of healthcare plans through work are getting worse and worse - and yet people don't want to be a "socialist" and have universal healthcare, and probably save money.
 
GritNGlitter said:
My husband's psoriatic arthritis meds won't be covered next year. He's on generics, but it's still ridiculous.
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And they say we have the best healthcare in the world.

Yes, PsA drugs are not covered next year for us either without getting the speciality drug plan. And the Co-Pay for the Brand names is $1,000. I don't know about the generics specifically.

One of the reasons we are seeing this is the fact that Speciality drugs have a profit margin 75% higher than regular drugs. Specialty drugs are drugs for rare diseases. And just 30 years ago with were pushing big to subsidise them so pharmaceutical companies would make them. They weren't making them before because they were not profitable. Now they are the most profitable drugs out there and a big cash grab from insurance.
 
Twentytwo said:
Well I have a High Deductible plan with a $3500 Individual deductible and those are not very good unless you have heart surgery like I did last year.
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We pay for insurance from my wife's work and I'm not sure we've ever actually made use of it because you have to hitbyour deductible before it covers anything at all. Having both kids in February where the pregnancy and delivery were basically 2 separate years set us back about 10K per kid.
 
dbarila said:
We pay for insurance from my wife's work and I'm not sure we've ever actually made use of it because you have to hitbyour deductible before it covers anything at all. Having both kids in February where the pregnancy and delivery were basically 2 separate years set us back about 10K per kid.
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Wow, I mean healthcare couldn't possibly be any worse. Pay more than any industialized nation. Hell I couldn't even get a Covid test without those crooks billing it as an office visit.
 
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Dtknuckles said:
it always funny when anti Medicare for all people start talking about wait times. Why about all the people that don’t get medical services because they can’t afford it? How are their wait times?
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I don't know if they played this ad everywhere but there was a Trump ad in PA that said Joe Biden wanted a government run healthcare and said it threatened Medicare. The irony was not missed by me.
 
dbarila said:
And most Americans are blind to the fact that we don't just pay more than any other country. We pay WAY more and it's not even close.
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Very true. For what we pay we could have the Rolls Royce of the Canadian healthcare system.


Also what's infuriating is the convo I just had with a boomer about our new prescription drug coverage next year.

It pretty much went down like this.

So, what's the big deal? Isn't that great that your employer is giving you choices on your coverage?

When I mentioned that most people probably won't sign up for it if they are a young healthy adult because they don't need it now, and it saves them money on ever increasing rates. They won't have coverage when they need it and it will be to expensive to afford. There either going to be in financial ruin or dead because they can't afford the drugs they need.

There reply was:
My wife has metastatic breast cancer and "specialty drugs" are what's keeping her alive. Just one of them costs $16,000 a month. I would gladly pay $20/month and the 1K copay. It sounds like a good deal to me. Just putting things into perspective.
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It's like our health insurance is the best because with can choose what we want. We don't have to pay for what we don't need. And when talking money. It's well, that's not all that bad when put into perspective.

However, I'm willing to bet that anyone considering not paying that $20 a month likely would not be able to afford that $1,000 co-pay. The co-pay itself is prohibitory landing them in the underinsured category. They can't afford to use their insurance.
 
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