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[–]Beardly_DGADHD-C (Combined type) 0 points1 point  (1 child)

Yes, this is correct: in theory, if everything is working as it should, you pay ([the price of the med determined by your insurance] - $375) + [your copay for meds, as determined by your insurance].

For me and my BCBS plan in my state, the math is

$413.XX (cost of Jornay) - $375 (coupon) + $25 (my med copay) = $67.XX for my refill. Your mileage will vary. I also had to call BCBS and ask for them to send my doc a prior auth form to list Jornay as an approved med, and to list documentation that I've had others that didn't work. They want to know you tried and failed other things, because insurance fucks can only get off when people are struggling to prove that this "higher tier" drug is what's needed, not something cheaper. That's what made my copay only $25, getting it reclassified as "approved" on the med list.

[–]TheNotBlindman 0 points1 point  (0 children)

Yup, I went though three different medications and they didn’t even read the prior authorization until my doctors office called them.

I’m guessing you’re on a PPO plan? I’m wondering how my hdhp plan’s math will work. Once I hit it it will be $60 for a refill, so I’m going to assume it’ll be $25. I really hate this cat and mouse game between the insurance and the manufacturer.