I’m hoping someone will be able to help me with my questions about how much I’m paying for my insulin through insurance (Cigna). I have a high deductible plan where I pay 100% of costs up to $3000, then 10% after that. I use humalog and tresiba, both in pens which I get in boxes of 5 at a time.
For the tresiba, the price is about $500, but I think my pharmacy has applying a coupon (which I found information about online - Tresiba coupon
The coupon says pay as little at $5 per prescription, with a max savings of $150. So before my deductible, I pay about $350, however the entire $500 gets applied to be deductible which is great for me! Then after I reach my deductible, I pay $5 per prescription with $50 getting applied to be deductible. This makes sense to me, but what I’m mostly confused about is my humalog prescription. My pharmacy seems to be using a coupon here as well but I can’t find any such coupon online. The full price for the humalog is also about $500, of which I pay $95 before I hit my deductible and $25 after. Again, the full price is getting applied to be deductible even though I’m not actually paying it. I guess I’m confused about how these coupons work and whether the full amount is actually supposed to be applied to be deductible as it has been. I’m also concerned the coupon will expire eventually and I will be stuck paying much more than I’ve gotten used to paying.
Any one more thing - I’ve been considering transferring my prescriptions over to the Cigna Home Pharmacy which will allow be to get more supplies at a time and they will be mailed to me which I think will make my life easier, however, I’m wondering if whatever coupons my pharmacy is using will work there as well and if Cigna is able to see that I’m using a coupon and not paying full price, will they only apply the amount I actually spent on prescriptions to my deductible.
It really depends. You will have to call both pharmacies. The coupon thing gets really tricky because you don’t always see whats going on behind the scenes. I have always found coupons pretty mysterious. They come from different players in the supply chain and can work differently, depending on who offered them.
Humalog paid my entire deductible in MN this year with coupons. That is because my state is suing them for price gouging. When I called to pharmacy to ask about the coupon, they couldn’t tell me anything. I got no useful information. The pharmacy has very limited information.
I had a similar discount with mfg novolog card. In my case, I think insurance still got the full amount, some from me, and somehow some from the mfg.
But was also surprised first time I saw it.
A question you could ask Cigna (or Cigna Home Pharmacy) is if they use a co-pay accumulator adjustment program. It should be an “either-or” question and it should be found somewhere in your plan documents.
If they do, then the amount of the coupon (or co-pay assistance) won’t be applied to meeting your deductible. In your case, it appears that Cigna is currently doing the right thing and they are not discriminating against whoever contributes to meeting your deductible.
I use Novolog . I got a coupon for a reduction of cost up $100.00
I pay a 30% copay( coinsurance) So if Novolog is 330 a vial retail
Two vials would cost 660, So I would be responsible for 30% of 660.
I would pay 198 for 2 vials. However, I have a coupon from the Novolog
people and it will reduce the price to 98,
The amount subtracted from my deductible will 198,
Due to the price of insulin and the coupon your deductible will be eaten up quicker.
Mail order. The only problem is waiting for it and if the postperson will leave it or they need a signature. Harder to resolve errors, Usally more cost effective.
Can get 90 days worth for the cost of 60 days.
Good points. I think I will switch over everything besides insulin for now and see how it goes and I will keep getting insulin from my normal pharmacy until something changes with the coupons.