Prescription Insurance Blues

My current employer recently changed the way it funds its employee health insurance policies--and its prescription plan.

I haven't been to a doctor since the change, which took place on the first of last month.  However, yesterday I went to pick up a refill for my estrogen (Premarin) prescription.

The last time it was refilled, in August, I received a 90-day supply for a co-pay or $45.  That had been the cost almost from the time I had my surgery, about five years ago.  Before that, I was paying ten dollars for a 30-day supply.

When I went to the Callen-Lorde pharmacy center, the clerk told me that, according to the current plan, I am allowed only 30 days at a time.

That, in and of itself, would have been nothing more than an inconvenience. But the next bit of news she gave me could have a real impact on my life:  It's now $81.24 for that 30-day supply.

When I called Express Scripts, who manages the plan, the person kept on saying "I hear you, I hear you."  When I asked for an explanation, he said, "Well, it costs more now."  Well, duh.  He said I'd have to contact the insurance company, whose name he didn't have.  

"That price is for in-person pick up," he said.  "If you want it mailed to you, you can get a 90-day supply for $243.72."  Now, the highly atrophied part of my brain that does math couldn't make the calculation on the spot, but it didn't sound like a discount--and, of course, it isn't.  

"So how did the price more than quadruple in the three months since I last got my prescription.  Did cows become an endangered species or something?"
(Premarin comes from pregnant mares.) He repeated, "It costs more now."  Then he gave an ever-so-helpful suggestion:  "You should call the insurance company."

That office--or, more precisely, the office of the person who administers the plan for my employer--was closed by that time.  I left two voice mail messages yesterday: one in the morning, one in the afternoon. The second time I called, I was switched to the main number, where I was told the person I needed to talk to was "out to lunch".  On Friday, you know what that means.

I hope to hear from her on Monday.  How, exactly, does a drug I need go from $45 for a three-month supply to $81.24 for one month?

Medicare Will Accept Applications For GRS Coverage

A US Department of Health and Human Services board has just ruled that Medicare recipients can no longer automatically be denied coverage for gender-reassignment surgeries.


Of course, this does not mean that every senior citizen who wants the surgery will get it at taxpayers' expense.  Rather, it gives Medicare recipients can seek authorization for the procedure by submitting a doctor's and mental health professional's documentation stating that the surgery is medically indicated in the applicant's case.


State-run Medicaid organizations as well as private insurers often take their cues from the Federal government in setting guidelines for coverage.  So, some have suggested, today's ruling could pave the way for gender-reassignment surgery becoming a routinely-covered benefit.


Such a prospect, of course, has opponents' knickers in a twist.  They believe that "anyone and everyone" will ask for the surgery and costs will rocket to the stratosphere.  However, even the most liberal estimates indicate that transgender people are no more than 0.4 percent of the population. Moreover, preliminary research indicates that coverage of medical treatments and procedures related to transgender issues has no discernible effect on the number of people who avail themselves to them.