If you don’t compare your med costs under Part D – YOU MAY BE VERY SORRY !

This is the first year that I have compared Part D programs for us.  Below is the “short version” of that comparison. Barb has had a part D prgm policy since its inception in 2006 with Silver Script (a CVS Health company) . She went on Medicare disability in 1996 and between 1996 and 2006 all of her medications were paid for “OUT OF POCKET”  It was not unusual during that time frame that for a 90 days supply of all of her medication would cost between $2000- $3000.  One of Barb’s medications required a PRIOR AUTHORIZATION and copay was $600 and change for a 90 day supply.  It wasn’t until last year that one of Pharmacists at the Winn-DIxie that we use while in Florida suggested that I use the “house drug card” that Winn Dixie uses that would bring the cost down to $190 and change for a 90 days supply… CASH AND NO PA… 🙂

Upon returning to our Indiana home, I discovered that at one of the BIG BOX STORES… I could purchase – FOR CASH – the same 90 days supply for < $90.

For 2020 Silver Scripts using the  https://www.medicare.gov/plan-compare/#/?lang=en to compare out of pocket costs of the various Part D prgms… if you are currently on a Part D prgm, all you have to do is create or login to Medicare and they will pull up all your meds to help you compare the costs of the various prgms available in your zip code.

Silver scripts has a stated cost of this particular med of $3520.09 for a 90 days supply and the new policy we are probably going to sign up for lists the cost as $97.42 after the deductible has been met.  With CVS health being the largest pharmacy chain in the country… and Silver Script being one of the TOP THREE PART D PRGMS …one would think that they would be able to purchase this med at or near the same cost as other pharmacies or PBM’s.

They also – sort of – play a trick with the $$ numbers… unless the pt is paying attention… they may not notice that the pt’s cost is the same before the deductible as it is after the deductible has been met… which means … IT IS NOT A COVERED MEDICATION…  pt MAY BE ABLE TO GET IT COVERED VIA A PRIOR AUTHORIZATION…. but still have to PAY HUNDREDS more than the medication can be purchased for CASH at many pharmacies.

Me on the other hand…  I take SIX GENERIC RXS and estimated annual cost via Silver Scripts is $1596.88 and thru the plan we are probably going to sign up for would be $294.24… I would not even meet the $450 annual deductible !!!

Caremark – the PBM that CVS Health owns – has been caught overcharging the Arkansas state employee prescription prgm https://www.kark.com/news/lawmakers-pharmacists-meet-with-cvs-over-regulation-of-pharmacy-benefit-managers/ as well as the Ohio’s state Medicaid HMO prgm. https://insurancenewsnet.com/oarticle/pharmacy-middlemen-reap-millions-from-medicaid

3 Responses

  1. […] If you don’t compare your med costs under Part D – YOU MAY BE VERY SORRY ! […]

  2. Medicare Part D 2020 for all SSDI and Medicare Age 65+
    Planning is essential. Since 2011 I discovered a secondary tool which compares Part D plans by individual State and Medicare Region.

    As a patient who was once caught off guard (before I knew about this website’s invaluable tool), I know how important next year’s formulary can be. And not wait for 2 hours at a pharmacy’s waiting area for an exception request.

    I am not a marketing person for Q1. Just a female patient who prefers advance planning for un-hassled Part D pharmacy dispensing.

    Go to http://www.Q1Medicare.com and check if your Rx medicines are present in next year’s Formulary. It is a very good mechanism to know via internet browser session and identify costs. Compare pricing, also.

    Good luck.

    Q1Medicare’s interactive tool can query your Rx medicine by brand name, generic name and NDC number.

    If there is a Prior Authorization, Quantity limit or Step Therapy for a particular Rx drug, its tool will identify this information. No need to be shocked with an ugly surprise at your pharmacy’s point of sale computerized checkout. Q1Medicare’s tool can help you successfully plan.

    If your Rx does require a Prior Authorization or Quantity Limit exception, you can find the form online by internet search. Many insurance companies advise their enrolled Medicare patients to have the doctor’s office “call” but my physician and I prefer a hardcopy paper trail.

    Once you finalize your decision to change Insurance carriers (Insurance-X to Insurance-Z) for a new Medicare calendar year, you coordinate in advance.

    Get all your ducks in a row….especially if Prior Authorization is involved

    Good luck! We are all planning for Happy New Year 2020! Think positive!

  3. THANK YOU STEVE!!! As I sit home alone on a saturday night, I was reading one of your news bulletins. I came across the one about checking Part D for drugs.But as I scrolled down I saw a cartoon figure with the character peeing on CVS!! That made me laugh out loud n giggle for 5 minutes!!! So thanks for making my Saturday night! And I would join the character if there was a way to get into the cartoon….

Leave a Reply

%d bloggers like this: