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Originally Posted by Northendzone
^ so what happens in the new benefit year?
Drug plans with maximums for life sustaining drugs are poor plan design. Maximums make sense for fertility drugs, or smoking cessation.
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Honestly, this is why pharmacare needs to be a thing, especially for life sustaining medicines like insulin. Sure it's more government spending now, but businesses won't be burdened by the cost of providing these benefits to their employees, people won't have to make hard budget choices, and the burden on the healthcare system that happens if people don't choose medicine as a result.
There should be some equity too. My kid is on some pretty expensive medications, but are super fortunate that it's effectively paid for by the government. It's not right that others don't have the same access to their needed medicines.
For the OP - another avenue could be if you have a connection in HR at your company like a benefits manager, they can make some calls as well to help overturn the decision.