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United Health Care

Posted: Aug 12, 2017 by    

aarp medicare advantage hmo-2 insurance plan

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United States
I need an expensive drug, Androgel, for which there is a generic equivalent. The plan includes Androgel in its formulary as a Tier 3 drug, but the generic is not in its formulary at all.

Androgel costs UHC over $12, 000/year and would cost me over $4, 000/year, even with UHC's coverage, because of Medicare Part D's "donut hole". The generic would cost me $1, 370/year with NO insurance coverage.

If UHC grants me a "formulary exception" to cover the generic, it is treated as a Tier 4 drug even though it is a generic, and would cost me $1, 360/year in deductible and co-pays, only $10 less that the drug's retail price.

My request is for the generic to be covered as a Tier 2 drug. This could happen either by UHC adding it to its formulary as a non-preferred (Tier-2) generic, or by treating a formulary exception for this generic as Tier 2 rather than Tier 4. In either case, my out-of-pocket costs would become zero, per the attached chart.

United Health Care

Complaint comments Comments (1)    Updated: Complaint country United States Complaint category Health & Life Insurance


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N  13th of Aug, 2017 by    0 Votes
Two BIG mistakes: Advantage, and UHC. Never, never!

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