For 2022, one of the two plans my employer offers added the following.
Those who rely on certain brand-name preventive medications for chronic conditions no longer have to meet the plan deductible before insurance begins paying a portion of the cost.
The only other link provided is the CDH Standard Plus formulary from the PBM, which oscillates between categories like “asthma/COPD inhalers and nebulizers” and all-caps brand names like HUMALOG and JARDIANCE (both for diabetes, I presume). I tried contacting the PBM for details on how this works with an HSA, but they didn’t really provide any clarity besides offering to mail me two copies of the entire formulary which would indicate covered drugs including preventives.
They also sent links to the 2022 Rx pricing tool (prices good through March, for some reason) which I played around with using things on the list. It doesn’t show that the “deductible” cost has changed, only that the “patient” cost is way lower. Also, the PBM’s “Go90” program is now in full effect so things lasting >90 days must come via Mail Order or (if generic) CVS…or else.
It makes more sense how this would work with the employer’s HRA plan, which has a $100/person Rx deductible, but I am not sure how this works with my HSA plan. During the open enrollment webinars, they sold it as basically 90% of people now being served by the HSA so why not switch. Is it technically not “first dollar” coverage because the employer is funding the drug via the PBM such that the insurer (Anthem) only sees a lower price? The only things on this list I would ever use are:
Non-OTC Flonase (Fluticasone), because the mucus faucet turns on whenever goldenrod or dust are in season. Aristacort (Triamcinolone), to prevent skin from chapping to the point of bleeding during MN’s cold winters. Might also be contact dermatitis, but the doctor isn’t sure. Prevident, OMS prescribed, as the back molars seem to be cavity magnets despite multiple fillings.
submitted by /u/34Dell17
[link] [comments]For 2022, one of the two plans my employer offers added the following. Those who rely on certain brand-name preventive medications for chronic conditions no longer have to meet the plan deductible before insurance begins paying a portion of the cost. The only other link provided is the CDH Standard Plus formulary from the PBM, which oscillates between categories like “asthma/COPD inhalers and nebulizers” and all-caps brand names like HUMALOG and JARDIANCE (both for diabetes, I presume). I tried contacting the PBM for details on how this works with an HSA, but they didn’t really provide any clarity besides offering to mail me two copies of the entire formulary which would indicate covered drugs including preventives. They also sent links to the 2022 Rx pricing tool (prices good through March, for some reason) which I played around with using things on the list. It doesn’t show that the “deductible” cost has changed, only that the “patient” cost is way lower. Also, the PBM’s “Go90” program is now in full effect so things lasting >90 days must come via Mail Order or (if generic) CVS…or else. It makes more sense how this would work with the employer’s HRA plan, which has a $100/person Rx deductible, but I am not sure how this works with my HSA plan. During the open enrollment webinars, they sold it as basically 90% of people now being served by the HSA so why not switch. Is it technically not “first dollar” coverage because the employer is funding the drug via the PBM such that the insurer (Anthem) only sees a lower price? The only things on this list I would ever use are: Non-OTC Flonase (Fluticasone), because the mucus faucet turns on whenever goldenrod or dust are in season. Aristacort (Triamcinolone), to prevent skin from chapping to the point of bleeding during MN’s cold winters. Might also be contact dermatitis, but the doctor isn’t sure. Prevident, OMS prescribed, as the back molars seem to be cavity magnets despite multiple fillings. submitted by /u/34Dell17 [link] [comments]Read Morer/HealthInsurance