Some policyholders allege the change has stuck them with 20 percent copays, or more than $900 dollars per monthly dose up to their yearly out-of-pocket limit, for the previously preferred treatment. Nonpreferred drugs typically have higher out-of-pocket costs for members than preferred drugs.
In response to patient and patient advocates raising concerns about the policy change on Twitter, Humana said, “We remain committed to helping our members receive affordable access to their treatments. Our #Herceptin Medicare coverage is the same as most other plans, but we realize recent changes may affect some members.” The insurer then asked members to send the company direct messages for support.
In a statement to Becker’s Hospital Review, Humana said, “We recognize the importance of medications like Herceptin. Herceptin remains covered in Humana’s plans, as it has been since FDA approval. Humana’s 2018 Medicare cost-sharing structure for Herceptin changed under select Medicare Advantage plans in four markets and is now the same as most other Medicare Advantage plans and original Medicare.” The insurer added it “is working to identify patient assistance grants for members who may need them.”
More articles on payer issues:
Des Moines Register: Iowa Medicaid traps enrollees in endless appeals process
Mutual of Omaha enters Medicare Advantage market
Humana to raise minimum wage to $15 per hour due to tax reform
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