Medicare Part D prescription costs BEFORE deductible is met

[evxx]

Is there a way to learn what a prescription will cost under a Part D plan BEFORE the $435 deductible is met?

Medicare.gov only tells you the cost during the 1) Initial Coverage, 2) Coverage Gap, and 3) Catastrophic Coverage Stages. I don't believe it says anywhere that those prices don't apply until AFTER you've met your deductible.

Looking on plans' websites also only tells you prices after post-deductible coverage kicks in. (At least for UHC plans.)

I may be wrong, but the pre-deductible prices seem much higher, almost like the full retail prices nobody pays. Certainly higher than they would have been using GoodRx.com.

Are those prices controlled or negotiated at all by Medicare, or by the Plan? Should they be similar at Preferred pharmacies within the plan? Or could you save a ton by using a different pharmacy?

Pharmacists have said they can't quote a price until they run a prescription, so it seems unwieldy to have to physically take each prescription to different pharmacies just to find out the price.

It would be nice to know you're getting the most out of that initial $435, pre-deductible, spent on prescriptions.

Thank you.

 

[somarco]

The new Plan Finder has that information when you look at the detail report.

Look at the attached

And yes, the copay IS higher on drugs are subject to the deductible until after it is satisfied. That is the way it has always worked.

 

[LostDollar]

Is there a way to learn what a prescription will cost under a Part D plan BEFORE the $435 deductible is met?

Medicare.gov only tells you the cost during the 1) Initial Coverage, 2) Coverage Gap, and 3) Catastrophic Coverage Stages. I don't believe it says anywhere that those prices don't apply until AFTER you've met your deductible.

.............

It would be nice to know you're getting the most out of that initial $435, pre-deductible, spent on prescriptions.

Caveat, not an agent.

The planfinder actually shows exactly what you are inquiring about. The drug cost information has 4 columns:

Cost before deductible
Cost after deductible
Cost in coverage gap
Cost after coverage gap

Please keep in mind that choosing a plan just because it has no deductible, or because it has the lowest pre-deductible retail price for one given medication, may not be the best way to select a plan for a client.

edit
That information is shown in the pharmacy section of the plan finder information.
You will have to select various pharmacies to see the particular costs for each pharmacy and plan combination.
Asking clients for their pharmacy (or pharmacies) of choice is how I see agents limiting the amount of searching they have to do in relation to the lowest cost option.
end edit.

 

[evxx]

Thank you both for your reply. And very sorry I failed to see that.

I have a printout of the same website report from December that did not include that column. However, going into the site now does show that information. I'm not sure why.

Still, I'm shocked that the information is not available anywhere on United HealthCare's site for their own plans.

Again, thank you!

 

[somarco]

Still, I'm shocked that the information is not available anywhere on United HealthCare's site for their own plans.

Might be there. You just haven't found it.

You can say the same for medicare dot guv.

I used to do a fair amount of U65 business with Humana years ago (before Ocare). They had a very useful drug price finder. Didn't even have to log in to use it. They eventually figured out competitors were "spying" on them and switched to login access only.

In doing so they also locked out the agents that were selling their plans.

 

[evxx]

Might be there. You just haven't found it.

Might be there. You just haven't found it.

Not there on UHC.com, even logged in. At least that's what 3 different UHC reps said after 90 minutes on the phone.

I'm just glad it's now on the Medicare page, and grateful to those who pointed me back there.

 

[LostDollar]

I am having trouble getting back to some links I just had. Try looking for AARP prescription drug costs or something similar and see if that gets what you want. Using q1medicare, it looks like the MO plans are under the AARP name rather than the UHC name.

 

[evxx]

Yes, I was logged in to an actual Missouri UHC Medicare Part D plan that had been marketed under the AARP name. And, no, that information is nowhere to be found on their website, whether logged in or not.

(I tried to upload to upload a screenshot from the UHC website here, but was unable to. It shows Total Estimated Annual Drug Cost, Annual Deductible, then lists drug names, dosages, Quantity, Tier, Limits, Initial Coverage Stage price, Coverage Gap Stage price, and Catastrophic Coverage stage price for each drug. But NOT the "Retail cost" or "Cost before deductible" that are shown on the Medicare website.)

Thankfully, I don't need the information from UHC, thanks to the folks who pointed out I can now find it on the Medicare site (unlike before). The info I need is all there. Thanks!

 

[LostDollar]

I am able to get to the link again:

Estimate Your Drug Costs | AARP® Medicare Plans from UnitedHealthcare®