L1applicant

Hi everyone

I managed to see a specialist doctor around 2 months after I got on my company's medical insurance. The pharmacy called me and ask if I was given a co-pay assistance card from my doc as it will reduce my meds cost from $100 per month to $5

Anyway, I hadn't received this card from my doc's office so I applied for it myself online and I'm waiting to hear if I will be approved.

Does anyone have experience of using one of these types of card? I am wondering if there is a catch? It seems too good to be true. I'm unsure if there are any reporting requirements of any kind or anything else I should be aware of.

Thanks

Noorah101

Hard to say without knowing what kind of insurance you have. If you have an HMO, PPO, or EPO type of plan (where you pay a co-pay to see a doctor from an approved list of doctors), then that should also include a co-pay on prescriptions, which is what I think you're describing.

This should be part of your insurance card, not a separate "co-pay assistance card", and it should come from the insurance company, not the doctor.

Unless you're talking about something else completely.....

Rene

Nutmegger

I'm guessing too, but is this something provided by the manufacturer of a specific drug to help with the purchase of their product? If so, if it has been prescribed for the OP, he should be eligible.

SanDiegogirl

I was once given an "assistance to pay" card from a specialist in order to obtain, at a cheaper rate, a specific named drug, not a generic.

The drug was extremely expensive and presumably, in order to promote its recommendation by doctors and request/use by patients, the manufacturer set up, for a specific period, this 'special offer'.

I think this is what the pharmacist is talking about. Luckily I never had to have another prescription for the drug after the initial use.

I don't remember having to do any reporting as to the success, or not, of the drug's use.

civilservant

That, in one sentence, is what is wrong with US healthcare.

SpoogleDrummer

I've used one for for my wife's medication, it just reduces your co-pay, usually up to a maximum amount. I think it takes my wife's co-pay from $30 to $3 a month. The reason the manufacturer does it is to prevent you from just using a generic version, they still get a big chunk of cash from the insurance company (Who in turn will probably pester you to use a generic anyways) so it cancels out what they lose on the discount.

Giantaxe

And everyone who pays for insurance effectively picks up the tab. As civilservant notes, this is a great example of how screwed up the US healthcare system is, especially as drastically increasing drug costs is the biggest cause of health care inflation at the moment.

SpoogleDrummer

Either that or the insurance company changes the tier of the medication so they cover less of the cost.

L1applicant

Thanks everyone. I'm on a PPO plan and yes, from various calls with insurance, specialist and pharmacy, I am starting to understand that the purpose of the card is to encourage patients to go with their drug. I was told at my specialist appointment the drug costs 15k per year without insurance so I really had been worrying about it even with my PPO. The USA healthcare has taken me a few months to get my head around! I appreciate you all taking the time to respond.

L1applicant

Just to add to one of the responses above, the specialist wanted to put me on three drugs, when one has been working perfectly for me for two years. I told him I didn't want to be on the other two drugs as one in particular I took for six years and it made me tired/sicky but I eventually just dealt with it until I got on my current one. He said lets just try it for two months and I walked away with two shopping bags of meds! Seems a waste to me. Trying to follow the docs orders bit it is kind of annoying when they prescribe meds that I have tried and tested over ten years and know that one works. I will say that the service is next to none and I really like how they spend 1 hour pl

L1applicant

Think I filled up the text box there. Anyway thanks everyone for your responses. I was concerned that there may be some kind of reporting or tax issue with the co pay card