I am insurance shopping today-on the CO Health Exchange- and while I can see if a specific drug /CGM is on the various insurance plans formulary- I cant tell how much the cost will be. In the past one of my brand name prescriptions has fluctuated from $900 a month to $0 depending on the plan. I’ve called the pharmacy and without a member ID they can only tell me the cash price- not the covered price.
Anyone discovered a way to determine the actual cost of prescriptions / CGM / CGM supplies while insurance shopping?
I don’t think things are very transparent. In order to get specific answers you will have to call the companies. That can be time consuming and even then you might get bad information.
This year I was fortunate in being able to attend the Diabetes Innovation Summit. At the end of the day we broke into small groups and tried to come up with an innovation. My group’s idea was to actually solve this problem. The idea is as follows:
There are 30 million Americans with diabetes and a big portion of them turn to the Health exchanges for insurance. But it is very hard to shop for specific diabetes coverage. We could create a crowd sourced web site where everyone who does shopping in a state marketplace can record the information they learn by calling each company on policy coverage. for instance whether the BCBS plan covers certain prescriptions or pump supplies or not. As everybody calls the companies and then shares the information then we can get transparency and make informed choices.
good idea…wish it were already here! The reality is they don’t want you to know. Clearly.
With regard to calling the companies- I tried that -several different ones…and all they can tell you is “yes / no that drug is/isn’t covered under our formulary- it is considered a Tier “x” drug, no unfortunately I can’t tell you what your cost would be, but I can tell you the coinsurance is 30%” So infuriating!
You won’t find specific costs but that is ok, what you really want is the tiering and copay structure. For prescription drugs that will be in the formulary. Unfortunately even the formulary is not enough. If you use a pump or CGM you will want to know if it is covered under DME and what the co-pay is. And you also want to confirm that if you have a pump how your insulin will be covered.