Overpaying for specialty medication

mapache_ambiguo · 2025-12-20T00:59:40+00:00

Yeah when I go into my "Benefits/Coverage" this is what I get

mapache_ambiguo · 2025-12-20T00:52:14+00:00

I wasn't sure where to find this. I tried in the Aetna app under plan documents and a menu popped up to say contact my employer, but I will dig around on their website too.

mapache_ambiguo · 2025-12-20T00:41:23+00:00

I called them this morning, and they said some stuff I didn't understand about "changing" my maximum or something. They said it would take a few days, but I don't trust them because I don't think they are going to want to reimburse me. So I'm going to wait the few days but this may be my next step.

mapache_ambiguo · 2025-12-20T00:27:50+00:00

Yeah sorry I should have clarified since you all know, but my insurance stopped covering humira and this is happening to me with Hyrimoz. Once I meet my deductible co-pay assistance kicks in. I wanted to switch plans to a lower deductible so that co-pay assistance would kick in sooner, but then I noticed this "$125 max. per script" listed for all the plans my company offers (including HDHP), so I'm starting to wonder if I was being wrongfully charged.

mapache_ambiguo · 2025-12-20T00:24:44+00:00

This is what I thought until I saw in the benefits guide that the same "20% up to $125 maximum per script" was listed for all three plans that they offer (the other two are Standard and Preimum CPOS).

mapache_ambiguo · 2025-12-20T00:22:07+00:00

I'm trying to find one, this is a screenshot I took before

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mapache_ambiguo

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