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This issue hit my household this year in 2023. I have MS and am on a Genentech drug called Ocrevus that has very successfully stopped me from having MS relapses. My enrolled with the same insurance - Aetna - as previous years, but a slightly different plan. One day about a couple of weeks prior to a scheduled infusion, I received a call out of the blue from CVS/Caremark telling me that my doctor sent in my Rx and that they had already reached out to Genentech's copay program on my behalf and said the copay was all set. A quick check of the Aetna's website showed that they had already processed the claim, received copay assist payment and DID NOT apply it to the deductible. In previous years, the prescription was filled at the pharmacy at the hospital the infusion was performed. My doctor got prior authorization, the Rx was filled at the hospital and one big bill was submitted. After my responsibility was determined, I would send proper documentation to Genentech's copay program and they would put the amount on the copay card. I paid my bill. This year, I was cut out of the process, except for the infusion part which Genentech provides only $1,000 total copay assistance for. Since I never met my deductible under the copay accumulator program, CVS billed Genentech for the coinsurance remainder on the second infusion and I paid for the remainder of the second infusion out of my pocket. Genentech paid more and I paid more. Aetna made out. In fact Genentech made me go through hurdles to get the infusion center to prove Ocrevus was the drug infused because it was not on their paperwork - just the infusion. That would not have happened if CVS hadn't intercepted.

ALSO - while here - have you heard the update? A court has ruled Copay Accumulators unlawful except for cases with generics. Here is a link (I could send many, but here's a mainstream news site: https://www.morningstar.com/news/marketwatch/20231002268/court-strikes-down-federal-rule-that-sharply-increased-prescription-costs-for-many-patients

Thank you

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While I think this article is pretty good I need to request a correction. Our assistance didn’t expire, it was exhausted. It may not seem like a big deal, but it is. A certain dollar amount is approved for assistance and SaveOn SP bills that amount as our cost share right at the beginning of the year to make sure my specialty pharmacy had hopefully my employer can optimize that available assistance as soon as possible.

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