Can anyone explain why and how Medicare's drug pricing tool at Medicare.gov never matches up with the Insurance companies published prices? For example, the insurance company may say that a brand named drug is $45/month. Medicare may say it's completely different, like $36.78/month. Medicare's site
Medicare's drug pricing tool vs Carrier prices
- Thread starter keith365
- Start date
What does the summary of benefits say from the plan?
That's the only thing that matters.
Like this summary from CSG or the actual summary with formulary from each carrier?
Outpatient prescription drugs
Tier 1 (Preferred Generic)
Pharmacy Type 30 Days Supply 60 Days Supply 90 Days Supply
Preferred Retail: Not Supported Not Supported Not Supported
Standard Retail: $0 Not Supported $0
Preferred Mail Order: $0 Not Supported $0
Standard Mail Order: $10 Not Supported $30
Tier 2 (Generic)
Pharmacy Type 30 Days Supply 60 Days Supply 90 Days Supply
Preferred Retail: Not Supported Not Supported Not Supported
Standard Retail: $0 Not Supported $0
Preferred Mail Order: $0 Not Supported $0
Standard Mail Order: $20 Not Supported $60
Tier 3 (Preferred Brand)
Pharmacy Type 30 Days Supply 60 Days Supply 90 Days Supply
Preferred Retail: Not Supported Not Supported Not Supported
Standard Retail: $47 Not Supported $141
Preferred Mail Order: $47 Not Supported $131
Standard Mail Order: $47 Not Supported $141
Tier 4 (Non-Preferred Drug)
Pharmacy Type 30 Days Supply 60 Days Supply 90 Days Supply
Preferred Retail: Not Supported Not Supported Not Supported
Standard Retail: $100 Not Supported $300
Preferred Mail Order: $100 Not Supported $290
Standard Mail Order: $100 Not Supported $300
Tier 5 (Specialty Tier)
Pharmacy Type 30 Days Supply 60 Days Supply 90 Days Supply
Preferred Retail: Not Supported Not Supported Not Supported
Standard Retail: 33% Not Supported Not Supported
Preferred Mail Order: 33% Not Supported Not Supported
Standard Mail Order: 33% Not Supported Not Supported
Not CSG - the actual summary of benefits from the carrier.
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