Re: Re: Any Experience with United Healthcare?

January 10, 2008

That's fascinating - I agree about the switch to lower cost generics - however,

you have to be careful of their suggested switches. For example, both my wife

and I take Aciphex, which United suggests switching to Omeprazole (Prilosec) as

a generic alternative. We both tried the Omeprazole - it didn't work for my

wife (she still has an unused 90 day supply) and it made me ill. We both have

GERD, so you pretty well know right away when the drug doesn't work.

Regarding the 33% copay, that's an interesting concept. I get my shots at a

hospital, and Medicare (part A or B - I don't remember which) pays part with

BCBS, my Medicare supplementary, paying the rest. I'd love to know what the

real price of Xolair is. I receive EOBs from Medicare showing the hospital

billed something like several thousand dollars for the 375 mg shots I get, but

Medicare pays only about $300 and BCBS pays about the same. I wonder if there's

any sort of standard price for this drug. It always spooks me a little when I

get the memo billing from the hospital for about $10,000 for a couple of month's

shots, but then Medicare and BCBS pay about 10 or 15 percent of that and it's

covered. I'd hate to think of paying 33% of what the hospital is charging

Medicare and BCBS. Bummer.

Ohldepharte

----- Original Message -----

From: tiredofsteroids

Sent: Tuesday, January 08, 2008 10:58 PM

Subject: [ ] Re: Any Experience with United Healthcare?

I also have United's Medicare Part D drug insurance; mine is the

AARP " Preferred " version. I'm on a lot of meds in addition to all my

asthma meds and also noticed that some got moved up into Tier 3, but

they turned out to be only meds that are now available as generics so

they are just trying to " encourage " us to use generics when they are

available. I don't actually have a problem with that - I've never

had a problem with a generic drug myself.

Also, I don't know if you've caught this in either the 2007 or 2008

plan, but you can request that a drug be charged for you as though

it's in the next lower tier. I haven't actually tried to do it myself.

One more thing - I noticed that this year AARP's United plan for Part

D now covers Xolair, as a Tier 4 medication which requires a 33%

copay. Since I've been covered under Medicare Part B with only a 20%

copay, I panicked and called Medicare to clarify how mine will be

covered. Believe it or not, each individual gets to choose!!! Hard to

believe but the agent told me I am free to stay with being covered

under Part B even though I now have the Part D coverage. Finally, a

policy that favors the insured!!!

>

> Dharm - if my experience with their Plan D Medicare drug coverage

is any sort of a guide, I find they keep pushing more and more drugs

into tier three, which requires something like a $71 copay, while

they keep increasing their rates. Maybe it has something to do with

paying for that platinum parachute of over a billion dollars they

gave former CEO Wm. Mcguire. I plan on dumping them at my next

opportunity. Something else I've discovered is that I can buy some

of our drugs from Canada for less than the copay. I wouldn't hold

out much hope for United paying for Xolair

>

> Ohldepharte

> ----- Original Message -----

>

> From: Dharm Guruswamy

>

> Sent: Monday, January 07, 2008 4:27 PM

> Subject: [ ] Any Experience with United Healthcare?

>

> I switched from a Aetna HMO plan to a United Healthcare Definity

> (HDHP) plan this January 6th. Under Aetna approval for Xolair was

> pretty routine. There was even a form on their website for the

doctor

> to fill and send int for pre-authorization. Initially it was

covered

> under the medical coverage portion of my plan and subsequently

shifted

> to the prescription drug benefit. However, since Aetna runs their

own

> specialty pharmacy and managed the prescription drug benefit the

> process was pretty seamless.

>

> Now, United Healthcare does NOT cover Xolair under my plans

> prescription drug plan. When I called to inquire about coverage

under

> the medical portion of the plan the lady could not provide me

with any

> information other than the doctor has to contact them.

>

> Anyone else had any experience with getting coverag of Xolair

under a

> United Healthcare plan?

>

January 10, 2008

Holy. As a Canadian, I read these posts about

insurance in awe. Sounds uber complicated. How do you

keep track of everything???

the Canadian

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January 10, 2008

For what it's worth, here is what I gather from my insurance forms.

When I get my insurance statement, as close as I can figure out, my 150mg

shot, once a month costs close to $900--just for the shot. The doctor's office

charges $40 which is not allowable under medicare or my supplemental, but the

doctor told me at the beginning they would absorb that cost since his clinic is

also a research clinic for xolair (I am not a part of the study). But just

because that is what is says on the form doesn't mean that is what it actually

costs the clinic where I get my shot, as I think they get the xolair in bulk

supplies (or however it comes to them) as they have about 100 patients (not a

part of the research). I am just guessing here. I figure 900 is close.

Without medicare, my supplemental insurance co-pay would have been $368, about

30% of just the cost of the xolair.

I am wondering what the cost is to others. My dose is the lowest they give.

I can't imagine what the cost must be for those who take twice that two times a

month!

Terry <onabeach@...> wrote:

That's fascinating - I agree about the switch to lower cost generics -

however, you have to be careful of their suggested switches. For example, both

my wife and I take Aciphex, which United suggests switching to Omeprazole

(Prilosec) as a generic alternative. We both tried the Omeprazole - it didn't

work for my wife (she still has an unused 90 day supply) and it made me ill. We

both have GERD, so you pretty well know right away when the drug doesn't work.

Regarding the 33% copay, that's an interesting concept. I get my shots at a

hospital, and Medicare (part A or B - I don't remember which) pays part with

BCBS, my Medicare supplementary, paying the rest. I'd love to know what the real

price of Xolair is. I receive EOBs from Medicare showing the hospital billed

something like several thousand dollars for the 375 mg shots I get, but Medicare

pays only about $300 and BCBS pays about the same. I wonder if there's any sort

of standard price for this drug. It always spooks me a little when I get the

memo billing from the hospital for about $10,000 for a couple of month's shots,

but then Medicare and BCBS pay about 10 or 15 percent of that and it's covered.

I'd hate to think of paying 33% of what the hospital is charging Medicare and

BCBS. Bummer.