Do any of these drug calculators take into account troop?

[jack3454]

I have a client that is on around 20 drugs and the lowest MAPD is showing up as around $9k total drug cost for 2024. This was on medicare.gov and CSG. Everything I’ve read basically says no one will pay over $3k a year for their drugs in 2024.

Since the troop for catastrophic is is $8000 of what you paid and the drug companies paid, is there any way to know what someone’s out of pocket will be? If I tell this person her drugs will be around $9k, thats clearly wrong because of the new rules for 2024. What am I supposed to do in this situation?

 

[Chazm]

I don’t tell them what they should expect to spend total in drugs.
I tell them their premium, deductible, copays, and how they can hit the gap, what they’ll pay in the gap, and that they’ll pay $0 after the gap for COVERED drugs. That’s it.

 

[DonP]

I have a client that is on around 20 drugs and the lowest MAPD is showing up as around $9k total drug cost for 2024. This was on medicare.gov and CSG. Everything I’ve read basically says no one will pay over $3k a year for their drugs in 2024.

Since the troop for catastrophic is is $8000 of what you paid and the drug companies paid, is there any way to know what someone’s out of pocket will be? If I tell this person her drugs will be around $9k, thats clearly wrong because of the new rules for 2024. What am I supposed to do in this situation?

What that’s telling you is some of those drugs are not covered . Drugs not covered in the formulary are not part of the Troop and are paid unlimited out of pocket .

 

[Truce]

Here's the three reasons I've seen drug calculator totals above $3300 out of pocket for a member:

1) Uncovered drug- pretty easy to locate if the software says 7 of 8 drugs covered. Change the dose/formulation fixes some of these, and some are just not on formularies for various reasons.

2) Part B drugs. Somehow they show up in the RX search tool and can be added to a list, but they throw off the numbers by not counting toward MOOP. Had this happen yesterday with some tablets that go into a nebulizer.

3) This was a weird one and I need some help with it. Guy takes TWO separate RX for Vyvanse. Strict quantity limits for a controlled substance, which he seems to be over on Medicare rules. One RX is for 30mg and the other is for 60mg each filled daily. The calculator on Medicare.gov and connecture/sunfire showed each RX flowing through the phases normally but then never reaching the catastrophic. Huh????

I could use help with this last one if anyone has a clue

 

[jack3454]

2) Part B drugs. Somehow they show up in the RX search tool and can be added to a list, but they throw off the numbers by not counting toward MOOP. Had this happen yesterday with some tablets that go into a nebulizer.

I could use help with this last one if anyone has a clue

Yes!! I think this might be one of the reasons…Same thing with this person, had TWO Rx for albuterol…one was an inhaler, one was for a nebulizer. How do you go about figuring out if they’re Part B or D at that point??

Thank you!

 

[jack3454]

What that’s telling you is some of those drugs are not covered . Drugs not covered in the formulary are not part of the Troop and are paid unlimited out of pocket .

Got it, thank you!!

 

[jack3454]

I don’t tell them what they should expect to spend total in drugs.
I tell them their premium, deductible, copays, and how they can hit the gap, what they’ll pay in the gap, and that they’ll pay $0 after the gap for COVERED drugs. That’s it.

Thanks. Ill probably do this from now on.

 

[straightnochaser]

Yes!! I think this might be one of the reasons…Same thing with this person, had TWO Rx for albuterol…one was an inhaler, one was for a nebulizer. How do you go about figuring out if they’re Part B or D at that point??

Thank you!

Both are Part D