Any One Ever Help with Tiering Exception

Jul 8, 2016

  1. kstein
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    kstein Guru

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    Just curious as to the success rates or experiences of this. I have a client taking Prempro and the only Rx plan that covers it is a tier 4,40% coins. I called Anthem to get it covered as a tier 3 and am interested in seeing how the process plays out.
     
    kstein, Jul 8, 2016
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  2. somarco
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    somarco That Medicare Expert Guy

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  3. kgmom219
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    kgmom219 What's Next?

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    Find out what she is willing to do. Canadian ? Generic? Estrace and provera (2 pills instead of 1)?

    Premarin (prem) skyrocketed 50% in 2nd quarter. I really doubt they will move it to tier 3.

    And even if they do, its a 2016 solution. What is she going to do in 2017?

    If they want Premarin or Prempro, they are going to have to come up with cash or go with a Canadian RX.

    Or use it to meet the donut hole sooner. ;)
     
  4. somarco
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    somarco That Medicare Expert Guy

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    I have recommended BlueSky to clients for at least 10 yrs and used them personally for the last 5 or so. No issues.

    I routinely suggest people consider a Canadian pharmacy for higher priced drugs. In many cases it allows them to move to a lower premium drug plan as well as save $$$ on OOP drug costs.

    Also run across people taking Rx Niacin, Folic acid, etc and suggest they ask their doc if OTC is OK. Sometimes the difference in Rx and OTC is $100/mo or more.

    There is almost complete transparency with drugs, yet too many people never bother to check.
     
    somarco, Jul 8, 2016
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  5. yogooglethis
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    yogooglethis Guru

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    accordingto medicare.gov looks the the part d negotiated rate for prempro ( in fl.)is about 160.00 . so 40 % is about 64.00.how much is tier 3 on plan? may not really be a big whoop
     
  6. kstein
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    kstein Guru

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    Tier 3 is $30 copay, tier 4 is about $60. I've heard stories that getting a Tiering exception is easy and can be a way to look like a rockstar in front of a client.
     
    kstein, Jul 8, 2016
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  7. AllyriaRedbird
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    AllyriaRedbird Expert

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    Somarco, you mean Blue Sky Canadian drug company, right? I have a client on Premarin that would love to pay less since she never bought a Part D. (She wasn't a client back then.)

    And kstein, yea baby, :biggrin: we all want to look like rockstars!

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    Awesome tip Somarco! Thank you so much.
     
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