I have CVS for pharmacy benefits.
There are two levels of 'co-pay' for pharmacy benefits on my plan
* 30 day supply
* 90 day supply.
There are three tiers of drugs
2. preferred brand name
3. non-preferred brand name
30 day cost
2. 20% of cost or ( $25 min / $50 max)
3. 20% of cost or ( $50 min / $100 max)
90 day cost
2. 20% of cost or ( $62.50 min / $125 max)
3. 20% or cost or ( $125 min / $250 max)
Insulin is covered at 'tier 2 - preferred name brand'. Well, only the insulin listed on the CVS formulary. <cue evil movie music soundtrack>
CVS is also playing doctor with my life as Humalog was removed from their formulary in 2016, and Lantus was removed in 2017. I have switched from 10+ good, stable years of Humalog and Lantus (after switching from the ancient beef/pork R and NPH) because of CVS - not because Novalog is better. I am actually still using Lantus - the savings card from Sanofi is actually quite good - I paid $10 for three vials of Lantus at my last refill even though CVS doesn't cover it at all. $10! I have never paid $3.33 a vial for insulin, even going back to the 1980s! The actual price of Lantus was listed ~$299 a 10 mL vial. The card is good for a year...I'll see what happens after the card ends.
And now comes the insurance is really bad story: filling a three month prescription for (6) vials of Novalog for three mohths, with 'Inject 30-60 units daily before a meal' also written, because CVS requires the exact dosages and '(6) vials' is not good enough for them.
Well - do the math (the pharmacist certainly did): 90 days x 60 units = 5,400 units.
A vial is 1,000 units (100 units/mL x 10 mL).
The pharmacist would only give me (5) vials for 83 days. yet my copay was still for 90 days. At $330 a 10mL vial of Novalog x (5) vials = $1,650, 20% of that is above my 90 max copay so I ended up paying $125 for 83 days. In a year, I will end up paying four x (3) month copays and get only 11 months of Novalog. If my prescription had been written for 30-62 units a day...do the math...62 x 90 = 5,580 - the pharmacist would have to give me (6) vials.
I called CVS to complain. The answer after 30 minutes explaining and explaining again? The 90 day copay applies to any prescription written for 31+ days.
The USA healthcare system is seriously broken. Big surprise.