Part D Again

[Dave Fritz]

When it comes to Medicare Part D it paid for us to shop around and use the services of our county aging and disability specialist. We've been with the same company for a number of years in large part because the increase didn't seen worth the trouble of changing. This year the increase was a little more so we got busy. Using the medicare.gov web site we did an analysis using our formulary (drug list) and were surprised by the results. Enter the aging and disability specialist, she review our information and confirmed what we had found. We will have a significant savings by having shopped around. There's still time if you have any doubts.

[Michael Weber]

I check every year.

[Ken Fitzgerald]

We check every year. I shocked that the same company that has been our plan D provider for a couple years now has a plan that covers my 3 prescription drugs, in generics, at a cost of $0.50 per month! I stayed with the same company but changed plans with that company. I don't know how they can afford it.

My wife on the other hand, is staying with the same plan she's had for a couple years.

[Rich Engelhardt]

I called yesterday to see what my coverage situation looks like.
The plan I'm on runs $38 a month. The plan they recommend runs $76 a month.
Neither cover the medication I need to survive.

Looks like if I want to live past Dec. 31st 2023, I'll have to dig into my pockets and come up with $20,000 to cover the cost.

[Steve Demuth]

I called yesterday to see what my coverage situation looks like.
The plan I'm on runs $38 a month. The plan they recommend runs $76 a month.
Neither cover the medication I need to survive.

Looks like if I want to live past Dec. 31st 2023, I'll have to dig into my pockets and come up with $20,000 to cover the cost.

That's awful, Rich. The sheer randomness of formulary decisions in these plans is maddening (actually, the sheer randomness of almost everything about medical insurance drives me nuts, both personally, and professionally). But it's a bit surprising too. The enabling rules for Part D require every formulary to cover at least two drugs in every drug class or disease state, and requires them to cover all drugs in critical classes like immunosuppression and antineoplastic (cancer) drugs. They also have to have an appeal process to get coverage on a drug that is medically required but not on their standard formulary. I wonder if some more digging with an insurance specialist to guide you isn't warranted?

[Rich Engelhardt]

In the past a lot of times all it took was getting my doctor involved with the insurance company and they agreed to some type of reduction in cost.
It was still a kick in the face though - a monthly cost to me out of pocket was $175 month. Retail per month was $1200. The same medication sold retail in Mexico and Canada for about $11 for a 1 month supply.

That same medication can now be had as a generic - - but - - only in a nebulizer format, not an inhaler. The drug company has a patent on the inhaler itself so - or some component of it, so, the generic has to be different.

If I can't get it (the new stuff) covered and I can't get the old stuff, or the older stuff from before that, then I guess I'll just live it up New Years Eve and party like there's no tomorrow :D

[Bill Dufour]

Since you live in Ohio I would think a trip to Mexico would be welcome in winter to get a few months supply. Mexico has tightened up rules on antibiotics so you now have to have a prescription to buy them. I have no idea about other medicines.
I have gone to Nevada to buy certain paint and roofing stuff no longer sold in California. Probably have to do that if my water heater or furnace goes out.
BilL D

[Rich Engelhardt]

Bill, as much as I'd love to get away from the cold, my oxygen tanks are only good for about two hours & I'm only allowed 12 of them at any one time - so - I'd run out of oxygen a long way from home.

[Earl McLain]

Bill, as much as I'd love to get away from the cold, my oxygen tanks are only good for about two hours & I'm only allowed 12 of them at any one time - so - I'd run out of oxygen a long way from home.

It may also be good to check your area for a Federally Qualified Health Center (FQHC). They staff doctors and nurse practitioners (NPs) who either write prescriptions or note their medical files to allow a specialist to write the Rx to their own pharmacies. Pharmacy pricing is subordinated on a needs scale which can be pretty generous. Not all drug manufacturers participate, but i take a specialty injectible that is not covered by any of the Part D plans i could get here--but instead of running the $8,000/month drug through Part D i just pay under $50/month at the FQHC pharmacy. I get my other prescriptions from them also, but we run those through the Part D plan. One caveat is that i have to see our NP quarterly to get refills from the pharmacy (regulations for the FQHC program), but those visits could be virtual. Patients can still see another primary care provider if they choose, and specialists are, again, noted as a "referral" in the charts--but at least at ours, our existing specialists were fine. My chart just notes that "rheumatologist" and "ophthalmologist" are referred, but those docs are not named specifically.

Most FQHCs focus outreach to low income patients as that is what drives their funding--but can be accessed by anyone using a sliding fee scale. Might be worth a look especially for the pharmacy portion. Best wishes.