Jose V. Alcedo Health Net of California, Inc. Overcharges Subscriber Co-pay for Medicine Stevenson Ranch Internet, California
Subject: Health Net of California, Inc. Overcharges their Subscribers’ Co-pay for Covered Drugs
This report is regarding Health Net of California, Inc., Medicare Program that does not comply with their written Covered Drug List. This results to overcharging a patient for member co-pay.
It is written in Health Net's 2015 Jade Formulary (List of Covered Drugs) that QVAR a drug name for asthma treatment inhaler has a "Requirement Limits of QL (0.87 gm daily ". Health Net requires a co-pay of $45.00 per month for this drug as long as the 0.87 gm daily limit is not exceeded. This daily limit is equivalent to 12 puffs daily.
But, my wife uses only two (2) puffs daily. per as doctor's prescription. This is equivalent to only 0.145 g daily vs 0.87 g daily limit. My wife uses less than one fifth of the daily limit. (One inhaler of QVAR contains 8.7 g Net with 120 metered inhalations or puffs.)
Health Net told me that the way member co-pay of $45.00 is calculated is for one month supply of QVAR. Because my wife took less puffs she ended up having one inhaler that lasted for two months. That's why they charge her $45.00 x 2 months = $90.00.
The consumer is penalized by paying more when for lesser usage. "More Pay for Less" -ridiculous!
This does not make sense to the Consumer. This is a real rip off.
Could anyone explain this to me?