Copay Armor Dupixent Questions
Hello,
I live in Pennsylvania and have a Highmark Platinum PPO Blue 100/80 plan. My In-Network (I only use in network services) Individual Deductible is $0 and my individual OOP is $4000. Coinsurance for PCP $20, specialist $35, ER $150. This plan is provided through my employer at no cost to me. RxGrp on card is HMRK001 and BCBS Plan is 363/865.
I suffer from eczema, uncontrolled Eosinophilic Esophagitis that did not respond to an elimination diet and PPIs, + allergic asthma. My allergist has prescribed my Dupixent, which was approved by my insurance. The copay for the medication is very high ($2000/mo), and it gets shipped to me via a specialty pharmacy. In the drug formulary, it’s a “Specialty Tier” drug. However, I received a call from a service called Copay Armor who helped me set up a Dupixent MyWay manufacturer coupon. This coupon covers $13k of expenses per year. However, since my cost is $2000/mo, that only covers 6 months of my med. I was informed that the coupon also resets in January, so really I will be covered in full for the next 12 months. They said after that to call them and they would do a manual override with my insurance to ensure that I still pay close to $0 for the med. I have never heard of anything like that before, and as best I can tell it seems like me per my insurance coverage that I’ll be paying that $2000 for 6 months after 12 months of the coupon. I had never heard of this so called manual override that this Copay Armor service says they can do. When I called member services on my card, they also didn’t know anything about that or how it works. Does anyone have any experience with this Copay Armor manual override thing? As far as I understand at worst I would have to pay for two months before my OOP max of $4,000 would be hit and then I would be able to get it for free anyways. I am fortune to be a software engineer and well compensated at my job so I would be able to afford such an expense but I’d like it to not be a surprise as it would require some financial planning on my part to do so.
Apologies for being all over the place. I am 23 and was formerly on CHIP/Medicaid for my entire life and all through college, so I am very unfamiliar with how the privatized health insurance system works
TL;DR: Does anyone know more about what exactly Copay Armor is as a service, and what this “manual override” thing that they do after a manufacturer coupon (in my case Dupixent MyWay card) has been exhausted?
