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Thread: Blue Cross - Update to your drug plan

Created on: Nov 30, 2017 @ 03:16 PM
Replies: 6
Blue Cross - Update to your drug plan
Nov 30, 2017 @ 3:16 PM
buddingartist
Rank #10


Joined: Feb 14, 2017
Posts: 10

1

I just received documentation from Blue Cross informing me of the increase in premiums as well as the changes in the plan.

I am particularly concerned about this "Managed Formulary" and what one must do if a new drug is prescribed and the process one has to go through before filling that prescription.

If I understand this correctly, if I am prescribed a new drug, I must first check with Blue Cross if it is indeed an approved drug. If it is, I can take the prescription to my pharmacist for filling. If not, I will need to contact my physician to discuss alternative treatments. I don't know how it works where you all live but in my case, that would involve making another appointment with my physician which is definitely not a question of days and could even stretch to weeks. Then if the physician prescribes another drug, I would have to repeat the process of checking with Blue Cross to determine if that drug is approved. I wonder how "many times around the block" would we have to do that? How is/are doctors supposed to know which drugs fall within the approved "Managed Formulary" and which don't.
Considering that we are all aging and that new medical conditions are almost a certainty, does Blue Cross even realizes the wasted time in securing the "approved" medication this could potentially entail, not to mention the delay in treatment which could potentially have detrimental effects to one's health/condition.

I am somewhat concerned as I have been diagnosed with IgA Nephropathy kidney disease and I don't know what the future holds, what meds could potentially be prescribed and my treating Nephrologist is 3 1/2 hours away from where I live.

Kind of upsetting how Blue Cross works around the issue by saying "YOU CAN ALSO CHOOSE TO PURCHASE THE DRUG OUT OF YOUR OWN POCKET. It's up to you." and this change, coincidental with an increase in premiums.

Am I understanding this correctly? Can anyone comment on this?

Louise Limoges

 

 

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RE: Blue Cross - Update to your drug plan
Dec 04, 2017 @ 10:26 AM
buddingartist
Rank #10


Joined: Feb 14, 2017
Posts: 10

2

Does anybody read or moderate this site?

 

 

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RE: Blue Cross - Update to your drug plan
Dec 04, 2017 @ 1:22 PM
GaryMitton
Rank #10


Joined: Nov 27, 2016
Posts: 12

3

I look at the site 3-4 times a week looking for new content.

I read you previous post with respect to Blue Cross coverage. My premium went down by $2 / month. I do agree with the terms of the terms because I do not believe insurance should cover the cost of any and all "new and improved" medications. More often than not, the new ones are no better and in many cases not as good as the "old" ones - just a lot more expensive.

Paying your own for a few months until the approval is obtained (or not). Any additional cost associated with the process would be, I assume, be more than made up if the approval is obtained.

Additional cost is deductible.

Gary Mitton

 

 

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RE: Blue Cross - Update to your drug plan
Dec 04, 2017 @ 10:37 PM
CNPAHEALTHCARECOMMITTEE
Rank #1


Joined: Jul 20, 2017
Posts: 4

4

Part 1
Well hello from the Health Care Committee, I will attempt to respond to the comments from the Louise Limoges - Gary -- I appreciate your comments as well. Louise you have my email, so feel free to contact me to discuss your issue further if you choose.
Yes the new formulary management process we will implement in 2018 will affect some of our members in the future. but an extremely small percentage(likely less than 1/2 of 1%) of our members going forward. When a drug is introduced to the Canadian marketplace, provincial governments and health care plans such as ours, review those new drugs against the drugs currently available for treatment. If there is current drug therapy available and it provides similar results, and likely at a lower cost, then the new treatment may be excluded. In most cases, something excluded by our plan may already be excluded by the provincial government formulary. I am sure when you meet with your doctor, you discuss treatment options, and if they suggest new innovative drug treatments, you may need to review if that treatment will be covered, and if not are alternative treatments are available and will they be equally effective. There may be some inconvenience, but it will be very minimal based on the number of people affected. I doubt people will be going around the block as often as you suggest. No one will be left without an effective alternative treatment. Again most insurance plans in Canada work in this fashion. If there is a special new treatment required, and not covered it will be available for review.

continued below

 

 

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RE: Blue Cross - Update to your drug plan
Dec 04, 2017 @ 10:38 PM
CNPAHEALTHCARECOMMITTEE
Rank #1


Joined: Jul 20, 2017
Posts: 4

5

Part II
Interesting a medication prescribed by my Doctor, that I was using was excluded this summer by the provincial government as equally effective alternatives were available. I discussed it with my doctor, who agreed that that any of a number of alternative drugs were just as good. When he prescribed one, which also had a generic option, my costs dropped by 80%. Leads one to wonder why I was prescribed the other drug in the first place or if Drug Company marketing had anything to do with the free samples I was provided first, then prescription.

Some of the new introduced drug treatments provided today cost as much as $150,000 or more annually. Many of these are covered by our plan because no alternative treatment is available. We are a USER pay plan. That means, the plan members premiums in a particular province fund the full costs of the benefits they receive. in Ontario in 2016, we collected about $2,950,000 in premiums. The plan members in the province claimed about $3 Million, as a result, the average increase was close to 0% in 2018 with some options slightly up and others down. With the exception of Alberta and Saskatchewan, there were similar results across Canada. But, what we need to also understand, while we have about 30,000 members and spouses in our plan, ONLY 150 of those claimed almost $4,000,000 of the $20M in total claims in 2016. We have a difficult time keeping increases low when drugs prices increase 6-8% per year. We currently don't have any annual or lifetime maximums like most Canadian plans, and if we did, many of those high claimants would not be getting any of their costs covered any more as they would be excluded by our plan. We may have to set limits in the future, but in the mean time, introducing this new Formulary program may provide us with some relief WITHOUT denying anyone any coverage for some treatment.

 

 

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RE: Blue Cross - Update to your drug plan
Dec 04, 2017 @ 10:38 PM
CNPAHEALTHCARECOMMITTEE
Rank #1


Joined: Jul 20, 2017
Posts: 4

6

Part III
While I can appreciate the inconvenience a few will experience in the future and it is unfortunate, but we need to also look out for the entire 30,000 people in our plan and our efforts to keep that plan available, at a reasonable price, in the longer term. You are fortunate that Ontario (along with Alberta) has one of the best provincial drug programs in the country for those over 65. As a result, your Premiums over 65 are almost the lowest in the country.

best regards ... Your CNPA Health Care Committee Chair

 

 

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RE: Blue Cross - Update to your drug plan
Dec 05, 2017 @ 7:14 AM
GaryMitton
Rank #10


Joined: Nov 27, 2016
Posts: 12

7

Committee, great reply and explanation.

I fully concur with the plan objectives and process.

Gary Mitton

 

 

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