Blue Cross Blue Shield Michigan...?

[rockherman]

With a Medicare Advantage Plan;

Medicare Plus Blue PPO-Assure

Aubagio is considered a Tier-5 drug!


Quoted a copay of $722.21 per month!



Found a form online;



This is a request to have a RE-determination of
the drug tier!

I waited a WEEK to get one because BCBSM told me it is
NOT available online.....guess what?

The web address is printed ON THE FORM!!!......


Maybe if enough patients apply with this form... the tier status might be changed?.....


This is my last recourse before going with the $722.21 per month copay!



I fill out part of the form and drop it off at my Neuro.
today for him to complete and fax back to Blue Cross Blue
Shield of Michigan.


I do not know IF it will work....but I'm OUT of options!


This sucks............


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[als5445]

I'm not sure exactly the details of your insurance, but I have BCBS advantage health care too. My copay for non generics is 10%, which would have me paying $350-$900/month for my Tysabri. Fortunately Tysabri has the copay assistance so I am only paying $10. That $350-900 that they would bill me however applies to my deductable/ out of pocket so I usually end up getting my out of pocket reached after about 4 months and the neuro visits and MRIs are covered in full. Does Aubagio have co-pay assistance? If so you can ultimately use the outrageous co-pay to your advantage.

[rockherman]

Copays.....

I agree....benn there done that.....it's just that a LOT of
things have changed for me this year already and I just
cannot do 600-800.00 every month for ONE med.


Out of options....last Tysabri infusion was early December
and nothing sence...startin' to feel like crap....


I'll keep looking...



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[onlyairfare]

You might want to check with the office of Michigan's Insurance Commissioner to be sure this is on the up and up.

I have found (when I worked as a health insurance executive) that the Blue Cross/Blue Shield companies generally are honest and follow the law. It wouldn't hurt to check and be sure that it is legal for the company to create a Tier 5 (most companies seem to have 4 tiers - generics, preferred brand names, non-preferred brands, and specialty drugs), and that such a high percentage co-pay is legal.

At present such rules governing insurers usually operate at the state level, so you could also seek to use political pressure with your own representative to change the law, if this is indeed legal. Co-pays of 25% or more for very high cost drugs effectively make them unavailable for most people. This affects not only us MSers but also millions of people with other auto-immune diseases, cancer, cystic fibrosis, etc.

I don't know if this will be any better when ACA phases in next year.