I recently turned 26 and purchased health care coverage through my employer (an HMO plan). I take a medication for ADHD regularly, and noticed that it is classified as a maintenance drug. My plan covers three 30-day fills per maintenance drug, and then coverage is decreased for subsequent fills. However, if you fill a 90-day supply with their contract pharmacy (express scripts), you can circumvent the decreased coverage by 1) filling 3 times at the lower rate (9 months of meds) and 2) getting better coverage for 90-day supplies (if you do the math at cost/day)
The federal government requires that Class II drugs be filled every 30 days, meaning that I cannot take advantage of 90-day supplies. This not only means that I cannot opt in to the cheaper route through Express Scripts, but also means that I will end up paying the higher coinsurance rate for 9 months of the year.
This plan is obviously set up to encourage participants to order their maintenance drugs through Express Scripts, but by putting the maximum fill stipulations in place, health care officials have indirectly "discriminated" against those of us who legally cannot mail-order/90-day supply.
I'm surprised there haven't been any legal suits against this. Why should I be required to pay MORE for my maintenance drug, as enforced by federal regulations? My argument isn't with the government, but rather with the health care plans. They should be obligated to make exceptions to the maximum fill rule in the case of drugs that are in-eligible for 90-day fills, etc.
Please share any news, posts, opinions you have on the matter.
The federal government requires that Class II drugs be filled every 30 days, meaning that I cannot take advantage of 90-day supplies. This not only means that I cannot opt in to the cheaper route through Express Scripts, but also means that I will end up paying the higher coinsurance rate for 9 months of the year.
This plan is obviously set up to encourage participants to order their maintenance drugs through Express Scripts, but by putting the maximum fill stipulations in place, health care officials have indirectly "discriminated" against those of us who legally cannot mail-order/90-day supply.
I'm surprised there haven't been any legal suits against this. Why should I be required to pay MORE for my maintenance drug, as enforced by federal regulations? My argument isn't with the government, but rather with the health care plans. They should be obligated to make exceptions to the maximum fill rule in the case of drugs that are in-eligible for 90-day fills, etc.
Please share any news, posts, opinions you have on the matter.
