2024 Drug List

[kgmom219]

For the newbies, I do this every year. Weird drugs that need a little extra information.

Starting off with Zioptan/Tafluprost!

No one has every covered it. Its preservative free glaucoma drops. MOO is showing covered. I have my doubts.

(And if you hijack this thread, I will hunt you down)

 

[somarco]

A Generic Version of Zioptan Now Available

If you or your patients have been looking for a new generic glaucoma option, Prasco, through its partnership with Thea Pharmaceuticals, recently began marketing tafluprost ophthalmic solution 0.0015%, which the company says is therapeutically equivalent to Merck’s Zioptan.
[EXTERNAL LINK] - A Generic Version of Zioptan Now Available



Tafluprost, tier 3 MOO Rx Essential.

https://www.singlecare.com/prescription/tafluprost-pf?q=Tafluprost (Pf) (Zioptan)

[EXTERNAL LINK] - Tafluprost Prices, Coupons & Savings Tips - GoodRx

 

[BALDELMO]

Helpful information,thank you.

 

[sman]

For the newbies, I do this every year. Weird drugs that need a little extra information.

Starting off with Zioptan/Tafluprost!

No one has every covered it. Its preservative free glaucoma drops. MOO is showing covered. I have my doubts.

(And if you hijack this thread, I will hunt you down)

The generic is definitely on their formulary as a Tier 3. I've confirmed it by downloading the formulary booklet. Be happy to send you a copy. Of course, this is based on Georgia, but I assume the formulary will be the same elsewhere.

 

[yorkriver1]

Don't shoot! Is it OK to ask if anyone else has seen the option to list other sources like Amazon pharmacy on Medicare Center/Accenture?
Not sure how that works, like are any of them network pharmacies?

 

[somarco]

Ozempic 1.5ml pen (apparently) not covered by any plan . . . only the 3ml pen

 

[kgmom219]

Ok, I am through 300 lists and ready to call it. I'm TX based, so this is a TX answer. And remember that 80% of my clients either pay IRMAA or appeal IRMAA.

1. My current SS Smart people are staying put. I tell them about the Wellcare 50 cent plan, but its not enough annual savings at this point to justify moving to a company/plan that has been fined by CMS multiple times for poor service and 1 star ratings. Most of them had it prior to 2023 and if I don't get paid, oh well.
2. The SS Smart drug list is horrific. I can't believe it got approved, but whatever. All I can do is advise people and remind them that they get what they pay for. But when you are happy with a plan, got a $3 increase and the deductible decreased, that's a tough sell. Plus, moving to WELLCARE.
3. Cigna is coming in consistently in the top 3, but not having Kroger is really hurting them. I have zero Cigna so far.
4. I am selling/renewing the crap out of the BCBSTX Choice plan. Even with a $9 premium increase, no one cares. The drug list is stellar. Interestingly, Walgreens and HEB are preferred, but CVS pricing is super close to Walgreens. Which is perfect for the SS Choice people who went from $24 to $41.
5. SS Choice is nowhere to be found.
6. Mutual of Omaha AND Wellcare both have some drugs I can't get covered elsewhere. Zioptan for MOO and...I can't remember what it is for Wellcare, but there are 2 clients going there for specific drugs that are only covered at Wellcare, according to both Medicare.gov and Wellcare website.
7. Humana and UHC are nowhere to be found. Which is interesting, since they are at the top of MAPD enrollment.
8. The trend continues for MAPD vs Part D pricing differential.
9. My UHC MAPD people are holding. My Humana MAPD people are pissy about increased copays and the MOOP. Moving them to BCBSTX or they are holding. I've got a THR/UHC MAPD nextwork issue looming for July 1.
10. I used Search and Save for the intake, but not running plans. Its worked about 90% of the time and well worth the $50/month. We are continuing to use Medicare.gov. I get a lot of positive feedback on this and it won't be changing.
11. Elixir and Amerivantage Part D plans are gone in TX and the members were NOT enrolled into a plan. These members have until 1/31 (it may be 2/28, but not sure if its a Medicare Termination (2/28) or Plan Termination (1/31), so safe answer is 1/31) I am absolutely disgusted with CMS over this issue. I have to get 457 forms signed showing I can be an agent and they are allowing people to not have a drug plan next year. So much for protecting some of our most vulnerable citizens-seniors with un-diagnosed dementia.
I AM LIVID OVER THIS OVERSIGHT.

 

[somarco]

I AM LIVID OVER THIS OVERSIGHT.

Life is easier when you don't have to put up with that kind of crap. It's the price I agreed to pay when I switched to Medicare only + PDP "consult" only (no AOR, no comp).

 

[DS4]

It puzzling why the Elixir people weren’t auto crosswalked?

 

[mdlovell]

10. I used Search and Save for the intake, but not running plans. Its worked about 90% of the time and well worth the $50/month. We are continuing to use Medicare.gov. I get a lot of positive feedback on this and it won't be changing.

Did you have to give a lot of guidance on the PURL for your clients?

90% would be awesome. 50% would be a win for me. I was concerned if it was intuitive enough for people to actually use smoothly.