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We went with BCBSTX at open enrollment this year because they have a good HSA option. In trying to decide which plan to pick for my husband we had our insurance person find out about Robert’s epilsepsy medications. It is contra-indicated to take generic epilsepsy medicines since they are allow to vary in strength by 80%-125% during the day (they are NOT the same as the brand names). There is quite a bit of medical documentation showing this. So anyway, the only reason why we didn’t select the HSA which would have costed $30 a month (after employer contribution) is because they said they would cover the brand medications for Robert. The only thing that insurance would pay would be for his meds, since his neurologist isn’t on the insurance plan.
At the end of October, we ordered 3 months of Robert’s meds. Brand names. Generics have been out awhile. They covered them under the normal copay. Yay, no problem.
Fast forward to early February. It’s time to refill. Robert goes to CVS to pick up the meds. They inform him that the trileptal will be $1200. $1200!!! No warning by the insurance that they changed the policy. Nothing. Robert calls Blue Cross when he gets home. It’s about 5:30 on a Saturday. He asked to talk to a manager so they put him on hold…for a long time. I get on the cell phone and call and try to get to someone. I get hung up on half way through the menu. I call back. Strangely the menu is different. I finally get to the pharmacy area and am told they are closed (it was 10 minutes before 6!). Robert is still on hold. They have no intention of even picking up his call, I’m sure. They are probably all logging off their computers and going home.
Monday, we find out that they changed the plan Jan. 1 (even though we can’t get OUT of the plan until Oct). We decide we have to get the meds so I ask CVS to change the order to 1 month. We go and get the meds and see that they also did generic for the lamictal. Get that rerun to just one month. For ONE month of meds, we paid over $550. AND we have insurance. We’re not uninsured; we’ve always done everything we can to make sure we have insurance. Not that is helps any. All it does is cost us money and doesn’t pay for squat.
They told us we would have to have the doctor fill out a form asking them to cover the brand name. He had to send them medical records, etc. He did. Today we got the letter stating that they don’t care what the doctor says, we will be forced to purchase brand name lamictal and trileptal. If I weren’t so scared of what would happen, we’d switch to generics, but it’s just not work the risk of Robert having a seizure.
Something to ponder… if we did the generic drugs and Robert had a seizure while driving and killed someone; would Blue Cross Blue Shield be at fault?
Just a little additional info. When we had Humana and the brand names came out, they tried forcing us to do the generics. But all the doctor had to do was put on the prescription that he had to have the brand names and they covered it. So not all insurance companies suck like Blue Cross Blue Shield.
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