Medicare Meds Not Covered

Nov 29, 2018

  1. Ins_Queen
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    Ins_Queen New Member

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    A new to Medicare has a long list of medications with five of them not covered by any Medicare drug plan that will cost him nearly $3,000 per month. According to the wife, her husband has severe allergies to the generics and has no choice but to take the named brand. I did a quick search at Canada Drugs Direct and these same meds are available for less than $200 a month. Naturally I want to leave myself out of the decision for liability reasons so the ultimate decision is theirs to make. But I still want to look for ways to give them some relief, and ultimately write a MS/Rx or MA. So my question is, beside manufacture discounts, have I missed anything or any suggestions on buy meds from Canada?
     
  2. somarco
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    somarco That Medicare Guy

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    somarco, Nov 29, 2018
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  3. fed up
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    fed up Super Genius

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    Although time consuming, manufacturer discounts and rebates are often making the drug 30 per month or so. My diabetes meds discount the initial price and offer 90% rebates. sometimes working with the pharmacist is a good choice as well. I have had one submit my script as not having insurance and I paid $10.00 for a 1500 drug
     
    fed up, Nov 29, 2018
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  4. DS4
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    DS4 Guru

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    I have a severe allergy to dealing with these types of people. In most cases, they just don't want to take generics.
     
    DS4, Nov 29, 2018
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  5. sshafran
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    sshafran Guru

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    Tell the applicant to start eating bacon.
     
    sshafran, Nov 29, 2018
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  6. russelltw
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    russelltw Guru

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    I have a couple clients who cannot take the generics. Generics are supposed to be at least 85% of the active ingredient, but can have sulfur or other fillers.

    According to one husband, the fillers almost killed his wife due to the reaction. They pay a TON for meds each year because she cannot take generics, so they know it will cost them. She does not use mail order because in the past mail order pharmacy would substitute generics in for name brands without her knowing. She no longer trusts any mailer order.
     
  7. goillini52
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    goillini52 BUILD THAT WALL!!!

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    Bacon does cure everything, but it needs to be American bacon...not that damned Canadian bacon. :yes:
     
  8. Newby
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    Newby Guru

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    If he really is allergic he can get what he needs. His doctor will know how to document step therapy to prove the allergies and then his drug company will approve the name brand.

    PS it will also prove that he is not allergic to the generic. Many people confuse the word generic for a Med that is not the same but used to treat the same condition.
     
    Newby, Nov 29, 2018
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  9. Ins_Queen
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    Ins_Queen New Member

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    I'll be sure to tell him to include bacon daily. His med list is rather extensive with some generics. Not sure what reaction he has with the five not covered. Gave the info I found and am moving on. Just one week to go!!! Count down mode to not waking before the sun is up and home after it goes down.
     
  10. Hopes
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    Hopes Super Genius

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    If a client is genuinely allergic to a specific medication,the doctor can request a formulary exception based on medical necessity.

    I had a prospect who had "reactions" to just about every generic of her prescribed brands until I showed her the difference in price and explained her options/lack of options.
     
    Hopes, Nov 29, 2018
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