Aetna/BJ retaliates against Obamacare -- and you

COMMENTARY

By John Olesky (BJ 1969-96)

Obamacare requires a 50% reduction in your co-pay for brand-name prescriptions once you hit the donut hole.

Aetna/BJ came up with a solution: Increase your co-pay BEFORE the donut hole to 500% of your 2011 co-pay on some generic drugs.

Example: In 2011 I paid $15 for a 90-day prescription for several of my generic drugs. In 2012 Aetna/BJ has increased that to $75. So, if I go nine months before I hit the donut hole, I will pay $225 for three 90-day generic prescriptions that cost me $45 in 2011. Aetna/BJ gets its money from BJ retirees in advance to help offset the 50% reduction in brand-name prescription co-pays. In my case, that's $180 more that I paid in 2011 for the same generic drug. And that's just for ONE prescription over three 90-day periods. That almost wipes out the $250 check we got when Obamacare kicked in.

By 2020 the reduction will be 75%. So Aetna/BJ will have to come up with other ways to increase your out-of-pocket costs to offset the "reduction" of Obamacare.

For those new to the donut hole game: Once you reach a specific amount of money that Aetna assigns as the "value" of your prescriptions, you previously had to pay 100% of the cost of the brand-name drug. Under Obamacare, that went to 50% in 2011 and 75% by 2020.

The donut hole, which kicked in at $2,840 in 2011, starts at $2,930 in 2012. And you don't get out of the donut hole in 2012 till you have spent $4,700. Notice that the calculations switch from the "value" of the prescriptions assigned by Aetna/BJ to get you to the donut hole to the actual money that you spend once you get into the donut hole. That way, it takes you longer to escape the donut hole, meaning you probably won't. The donut hole limit was $4,550 in 2011.

Businesses always stay at least one step ahead of the politicians. If politicians change the rules, then businesses just change the way they play the game. BJ retirees' out-of-pocket prescription co-pays are proof of that.