Insurance Coverage Change

CTBarristerMember

My firm is changing our group health insurance from Connecticare to Anthem effective November 1, 2012. Anthem is an HMO and fortunately my gastroenterologist is participating, so I am not going to lose him.

I was wondering about prescription drugs and I am worried about losing xifaxin. Anyone know if xifaxin or any of the pouchitis-combatting antibiotics are excluded from coverage by Anthem?

The copay tiers are 10/25/40 with Anthem and 15/30/40 with Connecticare. I am assuming Xifaxin, if covered on the Anthem plan, will be $40 as it was on the Connecticare plan.

Anyone know, especially those here in CT?

10/19/124:29 PM

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BreezieMember

In my experience, health plans are specific to employers. My husband has had the same insurance for a long time via three different employers and every plan was different, as was every co-pay. You'd probably need to look into the specifics of your plan and speak with the Health Plan Administrator or company rep to see what is covered and what isn't via the choices of your employer.

Who knows, it may be good news. With my last employer years ago, Humira was a $120 co-pay for a thirty-day supply. For my employer for the last seven years, it's been $20 per month, so I can't complain.

10/19/126:31 PM

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CTBarristerMember

I got a compare and contrast breakdown sheet from my employer between the old Connecticare plan and the new Anthem plan we start on November 1. All the copays are the same except an annual eye exam has a lower copay on the Anthem plan, and the prescriptions also have lower copays.

My concern is the meds being covered, especially xifaxin. It is no longer a given that these meds are covered with any copay. And I recall someone posting that their insurance carrier or HMO pulled the plug on xifaxin which I found to be shocking. I just can't recall what company it was.

10/19/126:42 PM

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ActiveUC'erMember

I've never had pouchitis drugs, but the most I've ever paid for my prescriptions (Anthem) was the top level (in my case 60, in your case 40). I have had some issues with pre-authorization though. Some drug prescriptions might require your doctor to fill out extra paperwork.

10/19/126:59 PM

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jeaneMember

I have anthem high mark ppo and xifaxin was not covered. I do believe it could be based on the employer also as vsl3 was not covered and we appealed it and my husband's company then decided to provide coverage. There is always that option with your doctor's medical note describing a need for a chronic condition.

10/19/127:42 PM

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CeeeeCeeeeMember

Suggestion: Ask for the plan's formulary for this year and the coming year to check on which meds are covered and at what cost, if any, to you. Then, if it's not covered, surely there is an appeal process....which will probably require beaucoup paperwork but will be worth it. Good luck!

10/19/127:52 PM

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