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Potential Cost-Savings for MS Meds & US Insurance Deductibles

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    #16
    Originally posted by Arzosah View Post
    I had been on Copaxone a dozen years, until they suddenly (with no notice) informed me that my copay had gone from $40 to 30% of the 'retail cost', which was $1400.

    The answer was; Specialty medications are needed by a small number of people, so when the Health Care bill happened, Kaiser had to find a way to spread the costs around, and that is how they did it.
    Kaiser did not "find a way" to spread the costs this was an intentional change of the Affordable Care Act (ACA). The ACA changed the law intentionally allowing insurance companies to charge patents 30% of the drug cost. This change hits the MS community disproportionately and extremely hard. The National Multiple Sclerosis Society, ACA sponsor, is more responsible than Kaiser for this change. Remember, Kaiser's profits are capped (by the government) so they aren't pocketing the 30% you pay them. Fortunately, my 75 year old mother now has full access to maternity, birth control and new-born care. Unfortunately, that means a large number of patients can no longer afford their medications they had access to before the law.

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      #17
      My Prescription Drug Costs

      are 40%, not 30%, of the cost. Is this a violation of the ACA?

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        #18
        ACA supposedly puts a total out of pocket cap on what you have to pay through your plan, but apparently there are exceptions - some companies/plans are given another year to comply, or whatever.

        It is not a violation of ACA to charge a $40 co-pay, and there is not requirement that the co-pay be a percentage of the cost of the drug. Putting a co-pay on some expensive drugs is a way for insurers to reduce their costs.

        Prior to ACA there was never a requirement for any company to offer health insurance at all and many plans that offered "health insurance" did not cover pharmaceuticals at all. Prior to ACA, insurance companies routinely excluded MS patients, or anyone else with a pre-existing condition that would be expensive for them to cover.

        Nothing new here, just another way to reduce costs for the insurance company. But if you have MS and can find a plan with reasonable drug coverage, ACA is a big advantage over not being able to uy a plan at all.

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          #19
          I just got off the phone with MS ActiveSource an I qualified for the $0 Co-pay assistance plan. I was told the plan is good for 1-year and pays up to $10,000. The discount code is being sent directly to my specialty pharmacy so my next shipment should be covered. My wife and I are so grateful to get financial help with this medication.

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