Drug plan quoting?

[vic120]

How are you all dealing with drug plan quoting

• I see most are now a % copay, the issue is (unless this year has changed) the base price is never right on Medicare .gov, in the past I have found a drug might list as $20 on Humana and $500 on wellcare,

If well care had a 17% copay and Humana had a 50% copay Humana would show less expansive

I have never felt comfortable running quotes on % copays for this reason, and have stuck with set copays , However seems this year there is not much of a choice

So how are you all dealing with this

 

[Fisher]

Never quote a dollar figure for percentage tiers. Ever.

 

[somarco]

I have never felt comfortable running quotes on % copays

Nothing you can do to change it . . . so roll with it.

Quite a few folks don't understand percentages. If I have 2 apples and give you 50% of my apples, how many is that? Some folks really have no clue.

Even if you help them work through the math of a 50% copay, how many will remember by the time the Rx is filled.

Even with a flat dollar copay the amount can change from month to month, especially if it is a generic. One of my wife's meds is less than $15 but we have never paid the same from month to month. One time it was $0.

I didn't complain, just swiped my card and told them to debit for $0 so I get my business write off.

 

[vic120]

Nothing you can do to change it . . . so roll with it.

Quite a few folks don't understand percentages. If I have 2 apples and give you 50% of my apples, how many is that? Some folks really have no clue.

Even if you help them work through the math of a 50% copay, how many will remember by the time the Rx is filled.

Even with a flat dollar copay the amount can change from month to month, especially if it is a generic. One of my wife's meds is less than $15 but we have never paid the same from month to month. One time it was $0.

I didn't complain, just swiped my card and told them to debit for $0 so I get my business write off.

Still its a big deal for tier 3 meds, many people are used to paying $40 or so for Xarelto even at 17% thats nearly $100

Unless i could get some accurate pricing how can I compare some with a high premium plan with set copays verse a %

Not sure how to do this

For many I would rather sell them the old WellCare model for $22 then the new one for .50 a month

but I really dont see much with copay structure till I get over $50

I dont even know what to do with this

 

[sshafran]

Had someone press me for a $ figure on Tier 3 w WellCare 20 minutes ago.

Told them I can't give them a number. They weren't too happy with that.

I said - it's a % and I don't know what that medication will cost in July 2024, and neither does your pharmacist - sorry, but I'm not going to pretend to know. It's 25%, and $0 per month for the plan ...or we could stay with your $58 monthly plan (or whatever it was) w the set copay.

 

[somarco]

Still its a big deal for tier 3 meds, many people are used to paying $40 or so for Xarelto even at 17% thats nearly $100

Unless i could get some accurate pricing how can I compare some with a high premium plan with set copays verse a %

Not sure how to do this

For many I would rather sell them the old WellCare model for $22 then the new one for .50 a month

but I really dont see much with copay structure till I get over $50

I dont even know what to do with this

There is no way to compare % vs flat dollar copay. If someone is on an expensive med like Xarelto or Eliquis show the copay plan. If they want another option. pick a CIPA pharmacy from this list.
https://www.cipa.com/cipa-safe-pharmacies

 

[vic120]

There is no way to compare % vs flat dollar copay. If someone is on an expensive med like Xarelto or Eliquis show the copay plan. If they want another option. pick a CIPA pharmacy from this list.
https://www.cipa.com/cipa-safe-pharmacies

How receptive are people with cipa

 

[somarco]

How receptive are people with cipa

I have recommended Canadian pharmacy's for probably 20 years and have not had complaints. BlueSky, and more recently, Maple Leaf are my "go to" Canadian pharms.

 

[kgmom219]

You can’t fix Congress.

2024 was always going to be a s**tshow to get us to 2025 and the $2K out of pocket

The best plan based on an annual cost is XYZ. BUT. Your Xarelto is now 25% not $47. As of 10/2/23, the 25% is WTF. But as you already know, drug prices can change frequently. Just like your drug list. So we do the best we can in October for the upcoming year.

(And make sure to look at the MAPD cost because if you don’t tell them, someone else will!)

 

[somarco]

You can’t fix Congress.

2024 was always going to be a s**tshow to get us to 2025 and the $2K out of pocket

The best plan based on an annual cost is XYZ. BUT. Your Xarelto is now 25% not $47. As of 10/2/23, the 25% is WTF. But as you already know, drug prices can change frequently. Just like your drug list. So we do the best we can in October for the upcoming year.

(And make sure to look at the MAPD cost because if you don’t tell them, someone else will!)

Reading assignment . . .

https://q1medicare.com/faq/FAQ.php?cat=monthly-formulary-changes&category_id=127

https://q1medicare.com/news/Article...ug-list-changes&article_id=994&category_id=20