When it was time to choose an insurance company for my MEDICARE "gap" coverage I called Medicare and worked with an associate for over an hour to establish the correct insurance carrier that would best serve my needs. I have been disabled with Behcet's Disease since 1986. There was a list of medications that I had been on for over five years when I spoke with the Medicare representative about the best carrier for my needs; the focus for my medi-gap was then and now strictly my medication coverage. With Behcets Syndrome the right dose, route & consistency of medications is EVERYTHING for optimal treatment of the disease and my Quality of Life! Taking these points into consideration the Medicare representative moved forward finding UNITED HEALTHCARE as the one who not only had each of my THEN 16 meds “Formulary”. All but one drug (Lovenox injectable) to be in TIER ONE! I signed up right away; even signing up for the EXTENDED HEALTH CARE POLICY to guarantee my meds would suffer no “donut hole” or “gap”. All of this extra care to insure these medications would stay within my very limited budget
Effective January 2009 I received a notification from AARP that two of my medications would stop being offered in Tier 1. One medication was taken off the covered list all together! The two medications that were moved to different TIERS were LOVANOX Inj (moved to 4) and FENTANYL (moved to tier 3…After conversations with my RX and my physician was moved up into tier 2). In approximately one month my Tiers 2-4 medications WILL NOT BE COVERED AT ALL, NO CO-PAY, NOTHING!!
I joined UNITED HEALTHCARE with the guidance of my assigned representative from MEDICARE. Our focus when choosing this plan was solely the importance of my medications and the need to have them “tiered” so I could manage to pay for them and by doing so, LIVE.
I have been on these medications for the over five years and took the United Health Care policy in good faith that they would continue to look out for my best health interests. Three of the drugs I have need for have been “adjusted” on UNITED HEALTH CARES-FORMULARY.
An example of one of these drugs and how the “adjustment” of TIERS equates to money coming out of my very fixed and limited income: The FENTANYL PATCHES give me the quality of Life that I need in order to function. This unfortunately is also an addictive drug so you can understand why I am frightened at this change of TIER. With just this ONE drug I will go from paying $5.00 to $6.00, then $7.00 last year (and the years since I signed with UNITED HEALTHCARE). Now, starting January of 2009 the same drug is $39.00 per month, come JUNE I will have no co- pay at all!! The approximate price of $350.00 per month!! That is just ONE drug out of pocket…ONE of 14 drugs that I am on.( I just wanted to note here that even TIER ONE drugs have gone up to $14.00 a co-pay.)
I feel so very ill looking over my potential drug costs when the “Gap-hole” takes place. If I do without I potentially can die. The Tier one drug increase during this “gap” period as well as the TIERS 2, 3 & 4 changes IS NOT what I signed up for. This issue was made clear when I signed up for my Rx benefits. It is not that I have recently been placed on the medications and I can work with my Doctor to find other formulary replacements…NO, I signed up understanding that my representative understood my need to have certain drugs covered. You signed me up with the understanding of MY RX NEEDS WERE TIER ONE, once signed I have no way to change my MEDICARE coverage.
NOW YOU RETHINK THE TIERS WITH YOUR FORMULARY DRUGS! This is unfair and not what I needed or expected!