I'm a sucker for a good deal. When I found out about the EpiPen and Auvi-Q $0 copay for 2013, I was so excited. As any parent of a child with food allergies knows, it can be expensive to fill new prescriptions each year. And it's all the more expensive having two kids with food allergies.
I am one of these people that likes to be prepared in all situations, so I keep epi in several locations. School, after school care, soccer bag, dance bag, home, an extra on hand in case one kid goes somewhere and another goes somewhere else.... It adds up. I even keep expired pens in the vehicles and in my purse for use in a pinch.
So I took advantage of the $0 copay offers last year and stocked up on EpiPen and AuviQ. My health insurance would only allow one fill (one twin pack) every 30 days for each child, so I made several trips to the pharmacy until I had enough packs to meet our needs.
When both companies announced they would extend the $0 copay into 2014, I did a little dance for joy! It wasn't until a few weeks ago that I decided I better start filling prescriptions again since the kids would be returning to school next month, and I would need to provide up-to-date meds.
At Bubs' well visit last month, I asked the pediatrician to write a prescription for one EpiPen twin pack for each of the kids with unlimited refills, since I was planning on filling again in the following months. I explained my desire to have several twin packs in several locations so we are never without. He obliged and sent the prescription in.
When I arrived at the pharmacy several days later, they had received the prescription but hadn't filled it yet (I'm still not sure why). After trying to fill it at that time, they realized they did not have any EpiPens in stock and would need to order some. So I said I would come back in a few days.
The hubs offered to pick up the EpiPens a few days later, and I told him it should be $0 due to the EpiPen coupon. When he arrived home empty handed, he said our (new as of January '14) health insurance wouldn't cover EpiPens and the cost was going to be $800 out of pocket! WHAT?!?
Of course, this was on a Sunday, so we couldn't reach any reps from our insurance. We looked on the website, and it said EpiPen and Auvi-Q are covered. However, when speaking with a rep the next day, we were informed that EpiPen is not on the formulary for our plan, thus not covered by insurance. However, Auvi-Q is covered as a Tier 2 drug and would be a $45 copay (which would then be covered by the $0 copay coupon from Auvi-Q). This was great news! I really like Auvi-Q and thought this would be a great opportunity to educate the school nurse and staff how to use a different type of autoinjector.
When the hubs arrived to pick up the Auvi-Q a few days later, the total was $300 for each twin pack! The pharmacist told us our insurance does not cover Auvi-Q, and the coupon only covers up to $299. So we would owe the remaining $300. No, no, no. This still isn't right. The rep told us this is a Tier 2 drug which is a $45 copay. Something's still not right.
On the phone again to a health insurance rep (which translates to whoever answers the phone). This time we are told that our plan states that Tier 2 and Tier 3 drugs are subject to deductible before the copay price is valid. Only Tier 1 drugs are not subject to deductible and the copay price is what we pay initially. After some digging, this rep told us that the Tier 1 option is the generic epinephrine autoinjector, and this would have a $0 copay on our plan. All we had to do was have the doctor write a script saying "Generic epinephrine autoinjector 0.15, 2 twin packs." The doctor also was to call the insurance for some sort of authorization. Great news! A generic autoinjector that would be free! Why didn't we do this sooner?
I so I called the doctor office.....again.....to ask for yet another prescription (I also had to call and get the Auvi-Q script earlier). I told the nurse exactly what was going on and explained what the script needed to say. She was quite confused and didn't understand that what I wanted was a generic and not an EpiPen! She was getting frustrated as I kept spelling out for her how to write the script. Then I dropped the bomb about having to call for authorization. She was appalled at this request. She told me they will often send in forms, but they never have to call! I explained that this is what the rep told us needed to happen in order for us to have life-saving medication for our children. She finally agreed, and I thought we were home free.
This morning the pharmacy called me to explain that our insurance actually does not cover generic epinephrine. I felt sick to my stomach and wanted to start crying! What do you mean they don't cover it? The rep was very clear about what needed to happen to get our epi. And it had all been done.
The pharmacist explained that she talked with both the doctor's office and our insurance and found out that the only epi our insurance covers is Auvi-Q, which has to go toward deductible first. She also quoted me an incorrect amount for our deductible, so I know the rep was wrong again! Sigh.
So here we are. Tonight I am going to pull out all my epi packs and hope that I have one that doesn't expire until some time in 2015 for the kids to keep at school. I can guarantee you that we will be switching health insurance companies come January 2015!
What a frustrating road full of misinformation and confusion. We have thankfully never used epi on our kids (although we should have at least one time), but still I will never go anywhere without epi in hand. It's too big of a risk. What have we learned from this experience? We will check our drug coverage and make sure epi is covered for a reasonable cost. This will be the deciding factor.