You know when you buy/pay premiums for insurance … you sort of expect to get some coverage… Barb has been on the same Part D program since it started in 2006.. Originally it was a company owned by the National Association of Chain Drugs Stores (NACDS) and National Community Pharmacists Association ( NCPA).. but the program changed hands several times over the years and ended up several years ago being owned by CVS Health.
Barb went on Medicare Disability in 1996 and for nearly 10 yrs she had no prescription insurance, I had to become accustomed to paying out $2,000 – $3,000 for a 90 days supply of her meds. Once she got the Part D insurance, I would get her meds filled the first week of Jan – 90 days supply and she would then be in the “donut hole”.. filling them again the first week of April and she would be in the catastrophic level… where her co-pays were only 5% for the balance of the year.
Over the years, as her brand name meds became available generically, the out of pocket co-pays continued to be less – by and large. She had a couple of meds that had PA’s and/or had been dropped from they formulary, but I had managed to get them to be covered. So as the end of a year came and went, we stayed on the same program.
This year, I noticed that her co-pays seemed to be MUCH HIGHER… what was $15-$20 co-pays now were $30 – $60 co-pays. I started really reading the pharmacy receipts and they put on there what the insurance paid and I was seeing a lot of receipts with SILVER SCRIPTS PAYING $0.00. In fact, in 2018 out of 13 Rxs… SILVER SCRIPTS paid $0.00 on ELEVEN OF THEM..
So I went to SILVER SCRIPTS website and downloaded Barb’s medication records for 2017 and 2018… and put them on a spread sheet.
In 2017, there were 37 prescriptions.. and SILVER SCRIPTS paid just at 50% of the total. When I totaled up 2018… SILVER SCRIPTS paid abt 15%… since all but one of Barb’s medications in 2018 was the same as in 2017. I was basically comparing apples to apples.
After digging a little deeper, it would appear that the independent pharmacy that we use.. is not one of their “preferred pharmacies”… in fact the county in which we live – population about 80,000 there are only TWO PREFERRED PHARMACIES… BOTH CVS’.. about 8 miles from our house and they are about 3 blocks apart… on one of the busiest and congested roads int the county, one is a former Target pharmacy, and her co-pays would be LESS, up to 40% less.. if I went to one of their PREFERRED PHARMACIES. In fact, in three adjacent counties, there is only TWO INDEPENDENT PHARMACIES that are part of their preferred pharmacy network.
Apparently, in previous years, rural pharmacies were automatically included in their preferred network. The independent pharmacy that we use, is the only pharmacy in about 5 miles.. about 2 miles from our house and if I can’t get out… Barb doesn’t drive anymore.. .they would deliver prescriptions to our home.
Digging some more, I found that if we paid twice as much monthly premiums, – a “different plan” .. that their PREFERRED PHARMACY NETWORK… included most of the chain pharmacies in the county, but not the independent pharmacy that we prefer to patronize.
Normally under Medicare/Medicaid… prices/allowables are FIXED and pts have a freedom of choice of providers. There is no such thing as “preferred providers”… the provider either participates in Medicare/Medicaid or they don’t. Is CVS HEALTH/CAREMARK/SILVER SCRIPTS making up their own rules as they go along ?
I was under the impression that Medicare Part D was suppose to be moving towards a straight 75%/25% or 80%/20% payments by 2020 and Pres Trump stated today on TV that Seniors were going to start paying LESS for their medications… Maybe SILVER SCRIPTS has raised prices so that they can claim to have lowered them when the President makes them go lower ?
I intend to make some phone calls..
Filed under: General Problems
For me, there’s been the Chronic issue regarding quality and authenticity, as well as accessibility to receiving a necessary script from my doctor who states that the CDC says that-what I need for my diagnosis is “ADDICTIVE”. So I am being Tortured and denied quality–effective meds because they say so.
The same thing is happening to us. Last year, our prescriptions for a month was a little over $100. Since the beginning of this year, our pharmacy bill is now over $400. We’ve used the same independent pharmacy for over 20 years. Our pharmacy could no longer be a “preferred” pharmacy for our PBM (OptumRX) because the PBM was reimbursing them well below THEIR cost of the medicine (at least, from what I understand). Arkansas just recently passed a law that is supposed to regulate PBMs and their reimbursement rates. Here’s what’s happening (at least, in Arkansas) from what I understand – PBMs are reimbursing the big chains at a much higher rate than independents. The reimbursements are still somewhat low, however, the chains can absorb the loss in with their huge profits. This is forcing our independent pharmacies to go out of business. My pharmacy is now having to charge us the remaining balance of what our PBM refuses to pay for.. If our pharmacy didn’t do this, they’d quickly go out of business. I’m not sure when this law will take effect or when our state attorney general, who says she’s “on top of this issue” (*eye roll*), will start looking in to this, but now that our state medical board is about to issue stricter regulations on the prescribing of opioid-based medication, I figure that we’re screwed. The guidelines are very vague, but the part where it states that if any patients are on more than 40 MEDs, there must be PHYSICAL proof of a patient’s pain, meaning more testing will be required to keep the medical board from screwing with our doctors. As we all know, there are many “invisible” illnesses for which does not show up on blood tests, x-rays, CT scans, etc. Arkansas is a pretty poor state with a lot of older people moving here to retire. Health care will go up. People in pain will not be able to afford their medications nor will they be able to afford more testing. Mark my words – Arkansas’ suicide rates and street drugs with pain relieving properties, along with alcohol abuse/overdose rates will all skyrocket. I despise what this country has turned into.
I’m going through this as well. My local pharmacy not being a “preferred pharmacy” but that CVS and Walgreens are, therefore, small to no % of coverage on meds and this is with BCBS Medicare Advantage plan
My sister has been in an active and dangerous untreated CDC standard state of emergency. Yet, both prescribing doctors involved in her “care” are in process of killing her by Forced Reductions-to the point where she has to take what she was supposed to take before the sneaky FORCED REDUCTIONS, leaving her So sick that her spleen Swells and she can’t leave the heating pad, and could have a stroke. Where Are The Advocates, Human Rights Watch ? I have severe Insomnia, intensified by both 5G Roll-Out, and notable anti sleep comonent added to the in authentic “opiate” yet none of my doctors will prescribe an effective sleep medication, such as the original Ambien. Which IS NOT an opiate!! The CDC must be threatening them in ways we are not Aware of. I haven’t slept in months, and was told that “We can only offer you Trazadon which I am allergic to and doesn’t work at all. There Isn’t Any other way to make sense of this nonsensical double speak, Except for The Fact that they want us to Suffer To Death, following Orders From our SOLD-OUT Government & Private Stakeholders. We need to get rid of them All ASAP, and hold them accountable for the mass Genocide that them & theirs are excluded from. Each breach of Oath to uphold the Constitution, makes all decisions after NULL and VOID !!