50 PDP Reviews and my thoughts

[kgmom219]

Wellcare is winning, but the devil is in the details. And they aren't winning by a lot, either.

A ton of drugs applying to the deductible at Wellcare.

"So Ms. Client, here are your options: pay the $0 premium and then $100 a month at the pharmacy for 6 months. Or pay $43 (Humana) premium, then $0 at the pharmacy".

And Humana is killing it on mail order pricing

And make sure you have Safeway (whatever it is called in your area) as part of the pharmacy list.

No idea where Cigna is in the mix. Either their files are wrong or the plan is crap.

 

[Midlevel]

Wellcare is winning, but the devil is in the details. And they aren't winning by a lot, either.

A ton of drugs applying to the deductible at Wellcare.

"So Ms. Client, here are your options: pay the $0 premium and then $100 a month at the pharmacy for 6 months. Or pay $43 (Humana) premium, then $0 at the pharmacy".

And Humana is killing it on mail order pricing

And make sure you have Safeway (whatever it is called in your area) as part of the pharmacy list.

No idea where Cigna is in the mix. Either their files are wrong or the plan is crap.

If you really want to see what is kicking Wellcare's VS ass click on the button that says you have 25 Medicare Advantage plans in your area and see total cost on those plans with 0.00 ded, 0.00 premium and $47.00 Tier 3. If you have them available in your area.

 

[just-a-client]

In California, WC VS is $17.40, and for drug usage involving just some Tier 1 and Tier 2 drugs, Cigna Assurance, priced at $1.80, beats it.

Add a Tier 3 drug, and both Cigna Assurance and Cigna Saver (which has a slightly higher premium than Value Script, at $20.60), beat Value Script.

The equation is going to be different in almost all states because of $0 premium. Don't know why Value Script costs so much more in California, New York, and a few other states. In the case of those two, based on population they might have the most enrollees, but are they less healthy?

While Assurance applies $590 deductible to all tiers, Express Scripts PBM has arranged such low list prices for Tier 1 and Tier 2 generics that it makes almost no difference if you pay full price for them. (That isn't the same for most plans at all!)

I've never enrolled in a plan that didn't waive deductible for Tier 1 and 2 - out of paranoia that the list prices could jump. But that's never happened to me. How common is it? Do you avoid such plans out of an abundance of caution, even if the total cost of actual drugs used is somewhat lower during AEP?

Perhaps changing the equation, in my state Assurance has Tier 3=16% and Tier 4=49% coinsurance, while Value Script has Tier 3=25% and Tier 4=35%. (That's down from 50% in 2024.) If one doesn't have specific drugs to price out, just looking at those tier percentages, which one of the 2 would simply look like a smarter choice? 9 points better on Tier 3, or 14 points better on Tier 4? Do you ever consider those potential costs when suggesting plans? Of course Tier placement could have a much bigger effect than percentage.

q1medicare eventually shows the number of drugs in each plan's formulary, and how many are in each tier - I guess they get that from some Medicare landscape files. Has anyone ever confirmed that their stats are accurate? That's another factor I weigh against Tier pricing.

Unfortunately from what I've read here, there aren't commissions for Assurance, and maybe not Saver, let alone Wellcare. Outrageous.

 

[DS4]

The first Plan Finder I ran was on myself. I currently have WC Value for $.40.
Even with the new $17.40 price, still what’s best for me.
My problem? My IRMAA tax.
I’d be better off NOT having Part D and using GoodRx.
In Ca, we have 17 Part D plans. 7 plans pay full commission

 

[Chazm]

I ran a drug called Orencia, through S&S. The Only company to cover it was UHC preferred as a Tier 5.

I told my client this and she said, “I ran it on Medicare dot gov and saw one other company covering it.”

I went there to check and sure enough Cigna covers it too. I believe S&S gets their medication info from Connecture, so be careful on running rx quotes right now.

 

[hockeyday]

I ran a drug called Orencia, through S&S. The Only company to cover it was UHC preferred as a Tier 5.

I told my client this and she said, “I ran it on Medicare dot gov and saw one other company covering it.”

I went there to check and sure enough Cigna covers it too. I believe S&S gets their medication info from Connecture, so be careful on running rx quotes right now.

i have received multiple emails today to only trust med.gov carriers and fmo , sunfire is completely useless

 

[GoPokes]

i have received multiple emails today to only trust med.gov carriers and fmo , sunfire is completely useless

Well dang that sucks. Historically, I dont seem to remember anyone trusting med.gov for the first few weeks of October.

 

[mkblinzler]

I am impressed that you ran 50 already!
Yesterday was good with M.gov and Lead Advantage but both were crapping out today for 2025. Fortunately my new clients today trusted me that the Humana or UHC plan worked for 2025 and we enrolled them now for 11/1 so we wouldn’t have to move again.

 

[kgmom219]

I ran a drug called Orencia, through S&S. The Only company to cover it was UHC preferred as a Tier 5.

I told my client this and she said, “I ran it on Medicare dot gov and saw one other company covering it.”

I went there to check and sure enough Cigna covers it too. I believe S&S gets their medication info from Connecture, so be careful on running rx quotes right now.

I only use it for my 80% generic only people. My 20%-ers get Medicare.gov. Then I print to PDF, which serves as backup later. If it was wrong and you can prove it, Medicare will let you switch plans.

 

[yorkriver1]

I only use it for my 80% generic only people. My 20%-ers get Medicare.gov. Then I print to PDF, which serves as backup later. If it was wrong and you can prove it, Medicare will let you switch plans.

Seems some sources are not identical to Medicare.gov. Good idea to save the .gov list, which I normally do, haven't had to show errors so far. Into the plan year, as we know, costs can change, but also can show the original price if that helps. I have to remember to tell them the prices can go up mid year.
Also, quoted a person on a carrier website where the MOOP was well under $2000 for Ozempic and Januvia on the plan, can't quite reconcile that. The plan was UHC $0 deductible $85 ish premium. Haven't enrolled it yet, of course. Just surprising, did I miss a memo about how the $2000 limit is applied.