Cap on Meds

[Bitnis]

I was told by a friend that someone she knows had a transplant of some sort. She said this person has BCBS coverage and that BCBS was paying for "anti-rejection" medication for life.

I thought there was a cap on meds with BCBS? Is this something that may be covered under transplants?

I'm taking a good hard look at BCBS and Wellpath trying to decide my position on them here. I have Wellpath but didn't know about the cap on meds until this year when I needed it.

 

[TXINSURANCE]

It would help if you identified BCBS of what state?

They are all drastically different.

 

[indmedins]

Furthermore, BX has many plan designs to choose from.

 

[Bitnis]

BCBS of NC.

I thought the med cap was on all the plans.

 

[tryan326]

Did she mention the name of the plan she had?

 

[schoolofhardknocks2]

I was told by a friend that someone she knows had a transplant of some sort. She said this person has BCBS coverage and that BCBS was paying for "anti-rejection" medication for life.

I thought there was a cap on meds with BCBS? Is this something that may be covered under transplants?

I'm taking a good hard look at BCBS and Wellpath trying to decide my position on them here. I have Wellpath but didn't know about the cap on meds until this year when I needed it.

I've been an independent health insurance broker in NC since 2001 and I'm a producer for BCBSNC & Wellpath.

This particular comparison is one of my pet peeves with many (not saying all) Wellpath agents and their IMOs. I see the marketing materials all the time stating that Wellpath is identical coverage to BCBSNC. Not true, and I don't know how they're getting away with saying it is. The biggest difference is the one that you just stated. Wellpath and BCBSNC state a 2k annual max for name brand rx in their brochures. However, BCBSNC will pay for name brand drugs (Clearly stated on page one of the policy benefit summary) that cost over $500 per 30 day supply without applying to the 2k annual max. Call Wellpath and ask if they are just like BCBSNC in this regard...the answer I can tell you is no.

Wellpath can be cheaper depending on area and underwriting, but the coverage and access to in network docs and facilities are not identical. Not saying they don't have a place in the market, just saying most agents selling Wellpath tell their clients that it is the same coverage as BCBSNC and costs less...Not the whole truth.

 

[Bitnis]

schoolofhardknocks that's good information. That seems to be a good thing and a bad thing with the paying for anything over $500 for a 30 prescription. If the prescription is say $450 per month you are still going to come out of pocket for a lot of money every year. Although it's definitely better than Wellpath.

Can you get me an appointment with BCBS?

Thnaks for that info!

 

[schoolofhardknocks2]

schoolofhardknocks that's good information. That seems to be a good thing and a bad thing with the paying for anything over $500 for a 30 prescription. If the prescription is say $450 per month you are still going to come out of pocket for a lot of money every year. Although it's definitely better than Wellpath.

Can you get me an appointment with BCBS?

Thnaks for that info!

I agree with you that it could be a bad thing. With that said, there doesn't seem to be too many drugs with costs that exhaust the 2k max that cost under $500/30 day supply. As a matter of fact, I have hundreds of members and don't recall a single instance where the max was met. I forget the overall BCBSNC stat, but I think I've heard less than 2% of all members hit their max. I wish they would just do away with the max all together, but what do I know.

I'm sorry but I'm not looking to hire new agents at this time. If you want to be exclusive to BCBS I know of a few contacts that may be helpful to you. However, I wouldn't recommend being exclusive for any company. I hate the idea of being limited to what I'm able to show my clients.

 

[somarco]

there doesn't seem to be too many drugs with costs that exhaust the 2k max that cost under $500/30 day supply.

Is the $2k max aggregate or per med?

If there are plans available that don't have an Rx cap, they are preferable to a plan that imposes a cap.

So what if they don't apply the cap to meds costing over $500? What if they are on a couple of different cholesterol meds? Or multiple psych meds?

There are lots of ways to exceed $2k without ever buying a med that is $500.

 

[TXINSURANCE]

There are lots of ways to exceed $2k without ever buying a med that is $500.

Depends on definition of what is a med?

Is chemotherapy a med? What about self injectables?