Re: Changes in Insurance Coverage for 2007

[Guest guest]

that's interesting because I have Aetna as well and I have the exact opposite

case. I used to pay $500 yearly deductible and $101.50 per month. Now I pay

$40 per month. I didn't know they will ship a 3 mos supply. Thanks for the

heads up. I'll have to tell my doctor to write a new script!

Dharm Guruswamy <dguruswamy@...> wrote: I'm covered under the

FEHBP Aetna HMO for the National Capital area.

In 2007 a couple of changes were made. First, Xolair was moved from

being covered by the medical plan to being covered by the prescription

drug plan. This has the practical effect of now having to pay a co-pay

whereas I did not. On the positive side, now that is covered under the

prescription drug plan Aetna Speciality Pharmacy will ship a three

month supply instead of just one month at a time when it was covered

under the medical plan. The bottom line for me is that I now have to

pay $320 more a year ($80 copay every three months) BUT I don't have

to call every month for a refill.

Dharm Guruswamy

---------------------------------

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[Guest guest]

The ability to do this depends upon your plan. In my case, I have a

three tier open formulary in my plan. Xolair is a tier 3 drug and the

copay for up to a one month supply is $40. The copay for a

maintenance supply (up to three months) is $80.

I took some time to read through the plan brochure for 2007. Sure

enough in the fine print (not in the summary of plan changes was this

note) I found what appears below. The moral of the story is for those

on Xolair please take the time to READ plan changes and call to find

out about how much Xolair costs. In my case, I would have stil picked

Aetna but other plans still treat Xolair under the medical plan and

thus don't yet charge a co-pay:

Certain self-injectable medications, which have

been historically covered by HMO members'

medical benefits, will be covered under their Aetna

prescription drug plan. There are various medical

conditions treated with self-injectable medications.

Examples of some medical conditions treated with

self-injectable medications are: hemophilia, growth

hormone deficiency, multiple sclerosis and

Hepatitis C. Often these drugs require special

handling, storage and shipping. In addition, these

medications are not always available at retail

pharmacies. These may be obtained through Aetna

Specialty Pharmacy Network. Coverage for blood

modifiers used to treat such medical conditions as

cancer and kidney dialysis are not impacted by this

coverage. Examples of these medications include

Procrit, Epogen, Neupogen and Neulasta. Please

contact us at 1-800/537-9384 for more details.

I noticed that in the fine print of the Aetna plan brochure they had

noted that injectibles that had traditionally been covered under the

medial

I'm covered under

the FEHBP Aetna HMO for the National Capital area.

> In 2007 a couple of changes were made. First, Xolair was moved from

> being covered by the medical plan to being covered by the

prescription

> drug plan. This has the practical effect of now having to pay a co-

pay

> whereas I did not. On the positive side, now that is covered under

the

> prescription drug plan Aetna Speciality Pharmacy will ship a three

> month supply instead of just one month at a time when it was

covered

> under the medical plan. The bottom line for me is that I now have

to

> pay $320 more a year ($80 copay every three months) BUT I don't

have

> to call every month for a refill.

>

> Dharm Guruswamy

>

>

>

>

>

>

> ---------------------------------

> Never Miss an Email

> Stay connected with on your mobile. Get started!

>

>

[Guest guest]

I received a letter from Aetna about the formulary changes but I didn't notice

the phrase you are referring to. I'll have to call them to see if I can get 3

mos at a time. Thanks!

Dharm Guruswamy <dguruswamy@...> wrote: The ability to do this

depends upon your plan. In my case, I have a

three tier open formulary in my plan. Xolair is a tier 3 drug and the

copay for up to a one month supply is $40. The copay for a

maintenance supply (up to three months) is $80.

I took some time to read through the plan brochure for 2007. Sure

enough in the fine print (not in the summary of plan changes was this

note) I found what appears below. The moral of the story is for those

on Xolair please take the time to READ plan changes and call to find

out about how much Xolair costs. In my case, I would have stil picked

Aetna but other plans still treat Xolair under the medical plan and

thus don't yet charge a co-pay:

Certain self-injectable medications, which have

been historically covered by HMO members'

medical benefits, will be covered under their Aetna

prescription drug plan. There are various medical

conditions treated with self-injectable medications.

Examples of some medical conditions treated with

self-injectable medications are: hemophilia, growth

hormone deficiency, multiple sclerosis and

Hepatitis C. Often these drugs require special

handling, storage and shipping. In addition, these

medications are not always available at retail

pharmacies. These may be obtained through Aetna

Specialty Pharmacy Network. Coverage for blood

modifiers used to treat such medical conditions as

cancer and kidney dialysis are not impacted by this

coverage. Examples of these medications include

Procrit, Epogen, Neupogen and Neulasta. Please

contact us at 1-800/537-9384 for more details.

I noticed that in the fine print of the Aetna plan brochure they had

noted that injectibles that had traditionally been covered under the

medial

I'm covered under

the FEHBP Aetna HMO for the National Capital area.

> In 2007 a couple of changes were made. First, Xolair was moved from

> being covered by the medical plan to being covered by the

prescription

> drug plan. This has the practical effect of now having to pay a co-

pay

> whereas I did not. On the positive side, now that is covered under

the

> prescription drug plan Aetna Speciality Pharmacy will ship a three

> month supply instead of just one month at a time when it was

covered

> under the medical plan. The bottom line for me is that I now have

to

> pay $320 more a year ($80 copay every three months) BUT I don't

have

> to call every month for a refill.

>

> Dharm Guruswamy

>

>

>

>

>

>

> ---------------------------------

> Never Miss an Email

> Stay connected with on your mobile. Get started!

>

>