Drug costs discrepancy - Medicare.gov vs Carrier website

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.

I’ve been told numerous times that they pay no more than the tier copay. If the drug cost less then they pay less.
I’d have to do some research but I have trained by Ins companies that it’s the way it is

I’ve never guaranteed any pricing, other than, “you can pay up to this amount for each tier”. No one in their right mind would guarantee the Medicare.gov copays
 
I’ve been told numerous times that they pay no more than the tier copay. If the drug cost less then they pay less.

Look up "pharmacy gag rule"


Recent legislation (Oct 2018) lifts the gag rule. Since this happened under the current administration, with REAL bipartisan support, I am not surprised it hasn't receive much press.

Insurers and pharmacy benefit managers (PBMs) can no longer restrict pharmacies from providing drug price information to customers. On Wednesday, during a live webcast from the White House, President Trump signed into law a pair of bipartisan bills that has made 'gag clauses' in contracts an illegal practice.
Legislation Signed Into Law Prohibiting 'Gag Clauses' for Pharmacies

The bill affecting Medicare beneficiaries will go into effect on January 1, 2020, while the bill banning “gag order” clauses for commercial insurance contracts took effect immediately upon signing by President Trump.
https://www.healthlawadvisor.com/2018/10/19/new-federal-laws-banning-gag-clauses-in-the-pharmacy/

Comment: Just because a pharmacist is no longer PROHIBITED from telling you about lower prices does not mean they will VOLUNTEER that information. Drug carriers and pharmacy's make more money when the consumer is charged a higher price . . .

But there’s a catch: Under the new legislation, pharmacists will not be required to tell patients about the lower cost option. If they don’t, it’s up to the customer to ask.

The Pharmaceutical Care Management Association, a trade group representing pharmacy benefit managers, said gag orders are increasingly rare. The association supported the legislation. Some insurers have also said their contracts don’t include these provisions. Yet two members of Congress have encountered them at the pharmacy counter.

No More Secrets: Congress Bans Pharmacist ‘Gag Orders’ On Drug Prices
 
I had a situation 2 yrs ago with quoting on Medicare.gov and Wellcare PDP quote. I keep a copy of the print-out with a date. I had to argue for about 1.5 hrs with Medicare giving the wrong co-pay for a medication when in fact it was in a different tier. I use the argument that using Medicare.gov is the only authorized way to compare different MAPD or PDP's and their website gave wrong info, which I based my recommendation on their info. If Medicare program gives wrong info it can allow the client a SEP to change pllans. They didn't want to do it but they allowed her to change plans.
 
I have found in the last couple of years that it can make a real difference when quoting on Medicare.gov, that if you don't put in the correct"preferred pharmacy" you'll get prices much more expensive sometimes.
 
I have found in the last couple of years that it can make a real difference when quoting on Medicare.gov, that if you don't put in the correct"preferred pharmacy" you'll get prices much more expensive sometimes.

It has been that way for a while.

I use a spreadsheet that is updated every year in Oct showing preferred pharmacy's for the more popular carriers. When running reports for clients I use THEIR "preferred" pharmacy and compare against the carrier preferred pharmacy. I give the client of keeping their current pharmacy or changing.
 

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