Medicare Meds Not Covered

[Ins_Queen]

We talked about the formulary exception but I can't guarantee he'll be approved. The wife has been doing research on her own and knows the price differences for each. Actually kind of refreshing to work with someone that has done enough research that I don't have to dumb down my presentation. The ball is in their court, they can either accept what I'm recommending or not. Too many others for me to deal with this final week.

 

[somarco]

This person is a prospect, not a client.

I never lead with Rx comparison. Make them a Medigap client first, then run the drug report. Otherwise you will be doing a lot of charity work.

"New to Medicare". I assume you mean the prospect, not you.

They have 60 days, possibly longer, to decide on a drug plan. Up to 6 months for a Medigap plan.

If they are new to Medicare there is nothing magic about 12/7.

Formulary exceptions can take weeks. Even longer.

If they are on a short fuse it's time to fish or cut bait.

For them and for you.

 

[Packerland]

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.

Speaking of exceptions I recently had one of my clients get an exception for 4 1000 mg tablets of Viagra daily.

 

[Ins_Queen]

This person is a prospect, not a client. You are correct.

I never lead with Rx comparison. Make them a Medigap client first, then run the drug report. Otherwise you will be doing a lot of charity work. Nor do I. Sometimes it's okay to help someone just out of good will. It all equals out in the end. .

"New to Medicare". I assume you mean the prospect, not you. Yes, that's exactly what I mean. Spent 39 years in P&C before switching to Medicare 6 years ago.

They have 60 days, possibly longer, to decide on a drug plan. Up to 6 months for a Medigap plan. Yes, but they're chasing their tail blaming insurance companies for not covering "all" his meds.

If they are new to Medicare there is nothing magic about 12/7. Yes, I and they are well aware of the initial enrollment period.

Formulary exceptions can take weeks. Even longer. Yes, not risking my good reputation by telling them it's easy or that they will have a positive outcome.

If they are on a short fuse it's time to fish or cut bait. Already have, they are a distant memory now. Time to finish up AEP with willing players.