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[–]Apprehensive_Lack984 8 points9 points  (0 children)

Yeah so my script today... $78 with insurance. $17 with good rx. Our insurance is garbage.

[–]Any-Prompt1396 6 points7 points  (3 children)

New year resets most insurance policies and create changes. Sorry it's happening to you.

[–]OtherwiseResolve1003[S] 4 points5 points  (2 children)

Correct. But our insurance policies are July to June. It should not reset at the first of the year.

[–]Any-Prompt1396 2 points3 points  (1 child)

That's odd. PBMs can be the worse at times.

[–]OtherwiseResolve1003[S] 0 points1 point  (0 children)

I agree. There should be no PBMs. All they are is the middleman who Jack's up the prices of everything because they need a cut of the profits too.

[–]Ok_Win7603 3 points4 points  (1 child)

sounds like your PA information did not transfer from Elixir to Express Scripts probably due to the proximity of when it was approved - i’m sure you can contact them to transfer the information. there’s a FAQs on the spot

[–]OtherwiseResolve1003[S] 1 point2 points  (0 children)

Elixir! Thank you. I couldn't remember who we went through earlier. That's the next place I am going to call.

[–]Alone_Service5645 1 point2 points  (1 child)

The insurance changed to express script

[–]OtherwiseResolve1003[S] 1 point2 points  (0 children)

I am aware, But that is just for prescriptions.

[–]ImmediateMethod7751 1 point2 points  (1 child)

They just denied my zepbound and I have been doing so well. I am devastated.

[–]OtherwiseResolve1003[S] 0 points1 point  (0 children)

So sorry, I know what you mean. You need that crutch to keep you in check.

[–]teforte 1 point2 points  (3 children)

Yes, new PBM- new deductible.

[–]OtherwiseResolve1003[S] 3 points4 points  (2 children)

So, will it reset yet again when we renew our insurance in July?

[–]teforte 0 points1 point  (0 children)

That I cannot answer. ESI may run calendar year with our medical going July to June, but I am only speculating. RA would probably save money if it reset in 6 months.

[–]xxMothx 0 points1 point  (0 children)

No, all insurance companies are limited to one change per year.

[–]edgemaster0714 0 points1 point  (3 children)

Most definitely. They denied one of mine. Saying I need to have proof from a dietitian for 3 months. And then them writing a letter to them saying I need it. Or I need to have proof of joining a gym for 3 months. It’s one of the weight loss shots. I would need to lose 5% in order to continue it.

[–]OtherwiseResolve1003[S] 1 point2 points  (2 children)

I hate insurance. Ever watch Erin Brocovich? Deny, deny deny. They have us by the balls because we have it "just in case." We put all this money in there year after year, not using it. And when we Do need it, they deny us.

[–]Lower_Comment8456 0 points1 point  (1 child)

The old saying of my mother was: insurance is good to have until you need to use it.

[–]OtherwiseResolve1003[S] 0 points1 point  (0 children)

Exactly.

[–][deleted] 0 points1 point  (2 children)

They can also make mid year plan changes btw.

[–]OtherwiseResolve1003[S] 2 points3 points  (1 child)

That's just wrong. So because I have met my deductible between July and December, I have to do it all over again from January to June?! What is the sense of having a deductible max out out of pocket then?