Drug costs discrepancy - Medicare.gov vs Carrier website
- Thread starter J2727
- Start date
Mcare.gov get's pricing info from the carriers and imports into their data base. I believe Mcare only updates 2x per year.
I had some real problems a couple of years ago with SilverScript during AEP. Mcare reports were lower than SS. Sometimes there was a tier shift. Got chewed out by more than one client after the first of the year when they used their card.
One client is STILL pissed.
Fortunately I kept the copay reports so when client calls to complain I can show them why I recommended one plan over another.
I had some real problems a couple of years ago with SilverScript during AEP. Mcare reports were lower than SS. Sometimes there was a tier shift. Got chewed out by more than one client after the first of the year when they used their card.
One client is STILL pissed.
Fortunately I kept the copay reports so when client calls to complain I can show them why I recommended one plan over another.
- Thread starter
- #3
I know, that's what I'm seeing too. Drastic differences in costs between what Medicare.gov shows and the carrier websites.
This is an issue because I don't think there is another all-in-one drug cost comparison tool that gives you the lowest cost plans for drug costs (for both PDP and MAPD).
The alternative is more time-consuming - inputting the drugs in each of the carrier websites.
Just to be sure, you know a carriers cost may say a tier 2 is $17. But if the full cost of the Med is only $5, it will show $5. I know it may seem obvious, just making sure this isn’t an easy fix
I don't care what the copay report shows as the "retail" (total drug cost). Only thing that matters is the copay paid by the insured (your cost)
When a drug deductible is involved, which is nearly every time, I show the expanded (view all months) month by month report.
When a drug deductible is involved, which is nearly every time, I show the expanded (view all months) month by month report.
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- #7
OK, to clarify, because now I'm a little confused...
- Medicare.gov - You input the zip code, enter the drugs, and it populates various PDP and MAPD plans with their respective costs for those drugs. You can filter the plans by cost, name, etc.
- Carrier website - You go to the website of Humana, UHC, Aetna, etc., search for plans in a zip code, enter the same drugs, and it gives the costs for all the PDP and MAPD plans.
- Carrier website - You go to the website of Humana, UHC, Aetna, etc., search for plans in a zip code, enter the same drugs, and it gives the costs for all the PDP and MAPD plans.
These costs are not the same. Medicare.gov shows much cheaper costs.
Chazm... can you clarify your post?
It seems Medicare.gov is in the wrong here.
Are you saying it's not and the carrier's website is in the wrong?
What I gather from Medicare.gov and each carrier's website is that they show the cost for the client, not the total cost of the drugs.
As Somarco said, only the cost to the client matters, which is what I'm assuming is being shown on Medicare.gov and the carrier websites.
- Thread starter
- #8
I’m not sure if I can clarify further but ill try.
I too only worry about the cost to the client, I’m not saying otherwise.
Let’s take Silverscript as an example. I think their Tier 2 medication cost $17. That’s the most you can pay for a tier 2 Med with them. But if you walk into a CVS and walk out only paying $5 for that medication, you may be confused. You ask the pharmacist and they tell you that the full cost of that Med is $5 so your drug plan didn’t save you anything.
That’s all I’m saying. Medicare.gov May show a lower price for a medication if it’s lower than the copay according to the insurance plan.
Pharmacy's can get in trouble with the drug plan carriers for doing that in most states. They are not allowed via their carrier agreement to advise customers of a lower price by paying cash, using coupon, etc.
That may change soon but AFAIK it hasn't changed yet.
I had a SilverScript problem last year. Mcare showed a particular drug (don't recall which) as tier 2 generic, no deductible. Client filled Rx in January and had to pay around $100. Checking with SS discovered it was actually tier 3 and subject to their new (2019) $100 deductible.
As indicated before, Mcare effectively showed a lower price than SS online. I was told that SS changed their pricing internally the end of Sept or first part of Oct for AEP. Was also told that Mcare updated their information in August so they "missed" the last update.
Unless I have missed it there are no disclaimers on pricing on the Mcare site.
Bottom line, you cannot and should not promise or guarantee any pricing report shared with clients . . . unless you like dealing with angry clients.
That being said, even if you took the time to run reports on carrier sites if tiers/pricing changes AFTER the report is run you are still in the same boat.
I give clients the copay run but also tell them to check with the carrier for current pricing.
That's about all you can do.
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