I am currently enrolled in a Carefirst PPO through my employer that uses Express Scripts for prescription drug coverage. For next year Express Scripts is implementing an unusual program through what appears to be a 3rd party company called “SaveOnSP” and I’m struggling to understand what exactly this means for my prescription drug coverage.
My company’s open enrollment guide doesn’t give much info on it, but it says the following:
“Enrollment in the CareFirst PPO plan offers additional savings with their SaveonSP program, which allows you to receive select specialty medications for complex conditions such as cancer and hepatitis C. Call SaveonSP at 800-xxx-xxxx with any questions or to enroll.”
Visiting Express Scripts website only gives very vague explanations about this program. https://www.express-scripts.com/corporate/solutions/lowering-costs#saveonsp
After googling this program/company and reading several articles I’m a concerned for what it means in regards to my coverage.
“Under copay accumulator adjustment programs, the assistance no longer counts toward the patient’s annual deductible or maximum out-of-pocket limit; in other words, only when the cost-sharing assistance is exhausted do patient payments count toward the deductible and maximum out-of-pocket limit.
This forces the patient to potentially pay thousands more in out-of-pocket costs over the course of the year for their health care. These programs are no more than a direct transfer of obligation from insurance companies and PBMs to consumers.”
So does this mean if I don’t enroll in this program I can’t get coverage for high tier medications, like those used for expensive cancer treatments? Is this effectively a way for my insurance to skirt around ACA regulations that put caps on how much I pay for medications? Something about how this seems really fishy to me, and the more I read up on this the more confused I become. If someone could explain this to me like I’m a child and give me a better idea what shenanigans Carefirst, Express Scripts, and SaveOnSP are up to here I would appreciate it.
I’m honestly considering switching to Kaiser’s HMO which my employer also offers so I can get health/prescription coverage all in one place just for the sake of simplicity, but I would miss having the same choices for hospitals and advanced care that I do with the Carefirst PPO.
submitted by /u/FuF_LP
[link] [comments]I am currently enrolled in a Carefirst PPO through my employer that uses Express Scripts for prescription drug coverage. For next year Express Scripts is implementing an unusual program through what appears to be a 3rd party company called “SaveOnSP” and I’m struggling to understand what exactly this means for my prescription drug coverage. My company’s open enrollment guide doesn’t give much info on it, but it says the following: “Enrollment in the CareFirst PPO plan offers additional savings with their SaveonSP program, which allows you to receive select specialty medications for complex conditions such as cancer and hepatitis C. Call SaveonSP at 800-xxx-xxxx with any questions or to enroll.” Visiting Express Scripts website only gives very vague explanations about this program. https://www.express-scripts.com/corporate/solutions/lowering-costs#saveonsp After googling this program/company and reading several articles I’m a concerned for what it means in regards to my coverage. https://thehill.com/opinion/healthcare/394376-the-latest-gimmick-in-health-care-to-make-patients-pay-more “Under copay accumulator adjustment programs, the assistance no longer counts toward the patient’s annual deductible or maximum out-of-pocket limit; in other words, only when the cost-sharing assistance is exhausted do patient payments count toward the deductible and maximum out-of-pocket limit. This forces the patient to potentially pay thousands more in out-of-pocket costs over the course of the year for their health care. These programs are no more than a direct transfer of obligation from insurance companies and PBMs to consumers.” So does this mean if I don’t enroll in this program I can’t get coverage for high tier medications, like those used for expensive cancer treatments? Is this effectively a way for my insurance to skirt around ACA regulations that put caps on how much I pay for medications? Something about how this seems really fishy to me, and the more I read up on this the more confused I become. If someone could explain this to me like I’m a child and give me a better idea what shenanigans Carefirst, Express Scripts, and SaveOnSP are up to here I would appreciate it. I’m honestly considering switching to Kaiser’s HMO which my employer also offers so I can get health/prescription coverage all in one place just for the sake of simplicity, but I would miss having the same choices for hospitals and advanced care that I do with the Carefirst PPO. submitted by /u/FuF_LP [link] [comments]Read Morer/HealthInsurance