• Report: #682100
Complaint Review:


  • Submitted: Thu, January 13, 2011
  • Updated: Fri, July 08, 2011

  • Reported By: M.J. — Pea Ridge Arkansas United States of America
Lexington, Kentucky United States of America

Humana Changes formulary yearly to lower their own costs. Lexington, Kentucky

*Consumer Comment: and....

*Consumer Comment: Here's why...

*Author of original report: You = 100% Rude and unnecessarily nasty

*Consumer Comment: You = 100% wrong

*Consumer Comment: Same thing in Arizona

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I have Humana prescription drug coverage through medicare. Every year they change their formulary to their own advantage. Every year my doctor and I have to change my most depended on prescriptions because Humana either drops them or puts them on another tier that makes them more than I can afford.

So far my doctor has been able to work around this and he changes mydrugs to the closest comparable drugs on the formulary that are in a tier I can afford.

Unfortunately they have finally managed to move or drop every comparable drug. There is nothing left in an affordable tier that even comes close to being able to replace the meds I am currently taking. The three most important drugs I take I can no longer afford.

To make matters worse all three are drugs that you have to be weaned off of because it is to dangerous to just suddenly stop taking them. I have tried to get them to help me every time this happens but it's obvious they could care less if I'm going to go through terrible withdrawals because I suddenly can't afford my meds anymore.

I don't understand why they make drugs to help so many conditions to give people more quality of life and then make them so expensive only the wealthy can afford them if you don't have insurance. Then the insurance you pay dearly for every month to help shoulder the cost does everything they can to pay less and less while they charge more and more for so-called coverage.

I am really scared of what's going to happen. I don't even want to think about what my life will be like without the meds that enable me to get out of bed every day. I have sculliosis and fibromyalgia and the pain is sometimes almost unbearable with pain meds. I'm terrified how bad it will be without it after I get through the withdrawals.

I have two children and I try to attend all their functions and activities. I try to attend all their fieldtrips and such. I worry that I will be unable to continue to do these things with them. It will break my heart and theirs if I will have to start sitting out of life due to the terrible pain I will be in again.

I urge you to find an insurance company that has their customers at heart. They are out there if you look hard and don't settle. Humana is not one of these. I was not notified of these changes in time to look for other coverage so now I'm stuck with Humana for another year unless I want to have to pay a penalty as well for the rest of my life.

On medicare you only have a short time at the end of the year to change your coverage to avoid a penalty. If you change coverage outside of this time frame then they will penalize you for as long as you have medicare coverage.

There are hundreds of insurance companies out there so be thorough!

This report was posted on Ripoff Report on 01/13/2011 09:56 AM and is a permanent record located here: http://www.ripoffreport.com/reports/humana/lexington-kentucky-40512-4168/humana-changes-formulary-yearly-to-lower-their-own-costs-lexington-kentucky-682100. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.

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#1 Consumer Comment


AUTHOR: I am the law - (USA)

.... and, no, I don't work for Humana.

I work for a major Chicago hospital as Director of Billing/Coding and have done so for almost fifteen years. I have Humana insurance as part of my job, but that's as close as I am to them.
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#2 Consumer Comment

Here's why...

AUTHOR: I am the law - (USA)

If Humana has no control over where they place their drugs on their tiers then why is it that they have tier change request forms for the patient and doctor to fill out and then they either switch it or not at their own discretion? - - M.J.

Easy answer: the document that you're talking about is a form of an appeal. In other words, if a drug ends up generating a very high member liabililty (such as a copay or deductible figure) based on the plan benefits, this is a request for the insurance company to make an exception and pay for more than they normally world. In lamens terms, it's a financial assistance request.

You need to get this "all insurance companies are evil and are just trying to screw you over" mentality out of your head.
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#3 Author of original report

You = 100% Rude and unnecessarily nasty

AUTHOR: M.J. - (United States of America)

You obviously work for Humana or something.  If Humana has no control over where they place their drugs on their tiers then why is it that they have tier change request forms for the patient and doctor to fill out and then they either switch it or not at their own discretion?  I don't claim to be an insurance expert and I would certainly never be so rude or act like I am so superior when I don't know all the circumstances about a person's predicament.  

I can tell you for an absolute fact that I pay them $110/month for prescription insurance only and then I pay for most of my meds as well.  I am not in the least embarrassed.  I have been disabled most of my adult life so I have spent a lot of time going over all aspects of the Medicare program.  I think it is a little odd that the meds that get switched to a higher tier each year always include the ones I'm taking that year. 

I work out a new plan with my doctor so that I can continue to get the meds that closest resemble the ones I require most and that I can afford only to have to repeat the process as soon as the new year begins.  I can't count the times my doctor has tried to give me a prescription to help my quality of life and to control the most extreme of my symptoms only to get to the pharmacy and find out that Humana won't cover any of it or they won't cover enough of it that I can afford to get it.  My prescription costs went from $20 a month to $120 a month from 2010 to 2011 and none of my prescriptions changed in any way.  My premium also went up $10 a month. 

I don't ask you to care but I would appreciate a little respect for a difference of opinion.  I was under the impression this was to inform and give people an insight into things they might not otherwise know to help them make an informed decision about what will be most beneficial to their lives and the lives of their families.  I didn't know it was an opportunity for immature contributors to bash people for telling the truth so that others might learn from it without having to find out the hard way.  It was not my intent to offend in any way.  I sought only to inform with my experience and learn from other's experiences. 

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#4 Consumer Comment

You = 100% wrong

AUTHOR: I am the law - (USA)

I beg to differ.....

"Levels" of drugs are actually dictated by the FDA and DEA, not insurance companies. Factors such as cost, control of the drug, whether or not there's a generic or OTC version, social demand, amount of similar drugs on the market, etc. etc. cause those drugs to bounce between levels.

For example, flu vaccines are typically level one. When the whole swine flu epidemic broke out a few years back, those drugs went to the maximum level JUST FOR THE SHEER BACK OF AVAILABLITY OF THEM AT THE TIME.  Now, they're back down to level one drugs. If the insurance company was so greedy, why wouldn't they just leave them at the highest level possible?

You need to research these things before you make accusations like that. Frankly, you're embarrassing yourself. 
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#5 Consumer Comment

Same thing in Arizona

AUTHOR: Shasiti - (United States of America)

They did the exact same thing to my husband after being reassured at the beginning of the year that the tiers will not change.
Call Humana and always ask for a manager, demand a tier exception form for each medication. Take that form to your doctor and hopefully with his help they will drop medication back to tier one. Also let people in your community know.

Tell people about your experiece in the pharmacy line, loud. Go to the senior centers and let them know. Write your congressmen, know it's a waste of time but documentation is important.
Report them to the AMA and the Better business bureau. Talk to pharmacy that makes the meds you need and see if they have any programs that can help.

I have AARP Secure Horizons and they have been wonderful! Hope this helps.

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