A Question of Ethical Referrals

[somarco]

Name one thing the government does that results in more affordable pricing that doesn't involve taxpayer subsidies.

 

[VaDwayne]

I hope this helps

60-day formulary change notice

Notice of Formulary Changes will be posted 60 days prior to the removal or change in the preferred or tiered cost-sharing status of a Medicare Part D drug. The posting will include:

• The name of the affected covered Medicare Part D drug.
• Information on whether the drug is being removed from the drug list, or changing its preferred or tiered cost sharing status.
• The reason why the drug is being removed from the drug list or changing its preferred or tiered cost-sharing status.
• Alternative drugs in the same therapeutic category, class or cost-sharing tier and the expected cost-sharing for that drug.
• Information for plan members on how to obtain an updated coverage determination or an exception to a coverage determination.

Note: You will also be notified in your Explanation of Benefits (EOB) about a drug list change 60 days before it takes effect.


Here's another example:


Can the formulary change?
Yes. CareOregon Advantage may add or remove drugs from our formulary during the year. If we remove drugs or add restrictions to a drug, we will notify members who take the drug at least 60 days before the date that the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the FDA deems a drug to be unsafe or the drug is removed from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.
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I have to disagree with that. The government can, and has, stepped in and regulated so much of our "free market" over the years. I think it's stupid that they don't protect the elderly people who helped make this country was it is today when it comes to their medications. It may sound naive, but in my opinion, surely an 85 year old getting their necessary medications is just as big a "right" as low income people having a roof over their head.

Of course, the insurance market in general is top loaded. The people in the most need are usually the ones that can't afford it. Look at LTC... I read just yesterday that the market for this product is people with substantial assets, but the people without substantial assets are the ones who will have the most trouble affording LTC costs later in life. It just seems backwards to me.

It will also be easier for the poor folks to qualify for Medicaid if necessary. I believe you must be down to 2000.00 in total assets to qualify for Medicaid. Wealthier people must lose their complete fortune to qualify, home, money; they have much more to lose.

 

[Frank Stastny]

I hope this helps

60-day formulary change notice

Notice of Formulary Changes will be posted 60 days prior to the removal or change in the preferred or tiered cost-sharing status of a Medicare Part D drug. The posting will include:

• The name of the affected covered Medicare Part D drug.
• Information on whether the drug is being removed from the drug list, or changing its preferred or tiered cost sharing status.
• The reason why the drug is being removed from the drug list or changing its preferred or tiered cost-sharing status.
• Alternative drugs in the same therapeutic category, class or cost-sharing tier and the expected cost-sharing for that drug.
• Information for plan members on how to obtain an updated coverage determination or an exception to a coverage determination.

Note: You will also be notified in your Explanation of Benefits (EOB) about a drug list change 60 days before it takes effect.

That's interesting. None of my clients who said their drug "fell off the formulary" have made any mention of receiving any notice. Maybe it is in 6pt type in a real light gray color. I will ask them next time I have an opportunity to talk to them.

 

[VaDwayne]

That's interesting. None of my clients who said their drug "fell off the formulary" have made any mention of receiving any notice. Maybe it is in 6pt type in a real light gray color. I will ask them next time I have an opportunity to talk to them.

How are thing in Missouri? Things are good here and I wanted to thank you again for the money to but sleeping bags.

 

[somarco]

From what I read, most folks don't need PDP and would be better off without it. Many times they can qualify for a PAP or discount that ends up being less expensive than the "negotiated" pricing of the formulary.

 

[gmveesaert]

Name one thing the government does that results in more affordable pricing that doesn't involve taxpayer subsidies.

Apparently, it's already been put in place, but I agree with Frank, it's probably in 6pt, light gray font at the very bottom of an already confusing EOB. I suppose requiring a prominent notification an 80 year old could possibly read would be too much to ask.