Seeking advice about what to do.

So I am in a bit of a problem. Last year I was diagnosed with Rheumatoid Arthritis and, at first, we tried to do low-cost medication. Unfortunately, the pain and swelling wouldn’t go down so we had to go for a higher priced prescription: Enbrel (~$2000-$3000 per month).

Enbrel has this co-pay card program that helps pay for the medication. And my provider (Anthem Blue Cross/Blue Shield of Virginia) works with a specialty pharmacist (CarolenRX) and they have a cost relief program. I was new to this whole thing and in a High Deductible Plan ($1600 deductible, $2500 out-of-pocket maximum) and thought that this would help me cover everything.

I was wrong.

The Enbrel co-pay card has a set amount and when it runs out, it doesn’t pay for anything anymore. Okay, that’s fine because I met my deductible right? Wrong. For some reason I don’t understand when I used the card to pay for Enbrel my insurance would adjust the amount to cancel out, so I still had a deductible to be met. I don’t fully understand it and no one seems to be helping me try to. (Copay accumulator laws in VA, or anything else. I even went to my company’s HR and they had never heard of a Copay card.)

Through CarolenRX, I thought I would be covered too. But turns out they only help with the out-of-pocket maximum when you meet your deductible. So right now, (after calculating the costs I have already paid for) I owe CarolenRX ~$1355.

Now that is a whole other bag of worms that I have to deal with. One of the current situations I am facing is my company is in Open Enrollment and I am wondering if I should stay with my current plan or if I should switch to the PPO plan. (Plans are in the post below).

I have to visit my Rheumatologist every 3 months which is about ~$200. I also have some other doctors visit when I need to refill my usual prescriptions (i.e. Meds for anxiety and depression) every 6 months which is like ~$100.

Given the current situation what plan would be good for me to choose? HR says to stick with the high deductible plan but I am not sure. I live paycheck to paycheck and have other bills to consider too (rent: ~$600, utilities ~$85-200, internet: ~$125, credit card stuff ~$200, phone plan ~$35, care insurance ~$75 (and increasing)).

I have until the 31 of this month to decide, so a quick would be great. Thank you!