Insurances changes & copay assistance programs

[my little penguin]

https://patientsrising.org/copay-accumulator/

http://pharmaceuticalcommerce.com/b...port-of-patient-reimbursement-says-trialcard/



Ugh

 

[crohnsinct]

For us with the Remicade assistance program it has always been this way. I seem to remember it was written into the program from Jansen. If Jansen was paying for the drug, then it couldn't apply to your deductible (which is money you are paying for care). It definitely was not our insurer because until we meet our out of pocket max, every claim has to be reprocessed because we receive benefit from Jansen. It is a nightmare getting things reprocessed and taken away from our deductible which of course kicks off reprocessing of subsequent claims down the line.

If all insurers are going toward this, one would hope they have the systems in place to process things accordingly.

 

[pdx]

Wow--I'd never heard of this and I hope it doesn't become more widespread.

CIC--Janssen specifically says that they will cover deductible payments, so I think your reprocessing probably comes from your insurance company. This is from the Carepath website:
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If you are eligible, you may be able to lower your out-of-pocket costs for REMICADE®, including deductible, co-pay, and coinsurance medication costs. With Janssen CarePath Savings Program for REMICADE®, eligible patients pay just $5 for each infusion for your REMICADE® medication costs, with a $20,000 maximum program benefit each calendar year.
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Thus far, our insurance company doesn't care about our payments from Janssen. We get our bill from insurance (we have a 20% copay on Remicade costs), pay our insurer, and then submit the bill to Janssen and get the money back; no reprocessing required. Most years we get back most of E's out-of-pocket expenses, since Remicade is by far our biggest expense.

 

[my little penguin]

The big difference is remicade is covered under medical
She similar to hospital or doc visits
This is specifically for drugs coming from prescription drug plan coverage where you have a deductible
Big difference
Since once you hit the deductible /max out of pocket on prescription drug plans
Drugs are covered 100%

 

[crohnsinct]

We saw that also PDX and the hospital coordinator for these types of programs looked into it and Jansen told her that what that meant was they will pay for the drug without holding you responsible for meeting your deductible first and the spirit of the program was not to help you avoid the deductible with your insurance company as that would be getting the benefit twice.

So for people like us with kids on Remicade, Jansen picks up the drug cost and then we still accrue our deductible for all our other costs, i.e. scopes, office visits, procedures, other drugs etc. Depending on the timing of infusions, my girls have met their deductible before they even get their first infusion of the year so it is sometimes not even an issue.

I think Jansen tows this line because the deductible issue is really a contract between you and your insurance company and if the insurance companies found out Jansen was encouraging this they could be dropped from the formulary.

There was also some discussion about this program with our tax accountant but I wasn't there and he handled everything so I can't really comment on that.

I have found however that the insurance companies really don't have any systems in place to deal with these programs so if you have been letting it count toward your deductible it probably won't be a huge issue but I would look to see if your insurance company has a policy on these types of things.

 

[pdx]

Our insurance is an HMO, and we have a $0 deductible on everything, so I guess that's why it hasn't been an issue for us? I've been open about everything with both our insurer and with Janssen.