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Here is a Federal website where you can see if any doctor/hospital is getting any items from drug companies: [EXTERNAL LINK] - Home | Open Payments Data - CMS
Need some help…19 Rx drugs and not sure what to do
- Thread starter jack3454
- Start date
- 2,265
One additional option. If her current prescription plan (through her current health plan) is covering the drugs, make sure to get ALL drugs refilled just before Medicare kicks in. That way you have a 3 month buffer.
ValeRosso
Guru
- 532
Nice resource. Turns out my doc has received $12 in payments. Im cancelling my membership immediately.
What you'll find is most doctors form of payment is the drug rep bringing them food or possibly taking them to lunch or dinner. There's a big misconception out there that doctors get paid a fee every time they write a prescription.
Some doctors do get paid handsomely to go a speak at events. But there's not a ton of those.
Special Agent
Super Genius
- 129
I always suggest that if appropriate and of course to ask for samples if it doesn't screw up their gap calculations.
A little off topic but something i never ran across before i recently had a client who received his his 90 day supply of eliquis in Jan 2024 at walgreens but it was processed as a claim in dec 2023 when refill was ordered by doctor.He was upset because it put him in the gap in dec 2024 and he was trying to time the refill to meet his deductible early in the year
- Thread starter
- #17
Steglatro
Ubrelvy
Qulipta
Then these are covered by some plans but then the plan wont cover other basic drugs on her list
Humalog INJ
Lantus SOL
1. Steglatro isn't covered. Needs to talk to her Endo. [EXTERNAL LINK] - Steglatro Alternatives Compared - Drugs.com [EXTERNAL LINK] - Steglatro Medicare Coverage and Co-Pay Details - GoodRx
2. I've got Ubrelvy covered by Humana, Aetna, BCBSTX, Cigna in 75081. So you lost me on that one
3. Qulipta isnt covered. (Its also $1K+). Talk to the doc and why she is on 2 migraine meds?
4. Humalog and Novolog are the same thing, difference manufacturers. Most diabetics understand that they are interchangeable and will switch based on insurance.
5. Lantus Solostar goes with Toujeo. Same answer as #4. Have her talk to her Endo.
When you get these, Good RX is usually pretty accurate, especially if you cant find it on the Plan Finder. Check GoodRx for Medicare and if says not covered, you've got another source.
Prescription Hope is a great resource. Remind them of the $2K max coming in 2025. Make sure you are using multiple pharmacies to compare.
AgentGeneral
Guru
- 289
Beautiful answer and so eloquently put. It's this type of guidance that helped me so much when I was getting started.
Jack - Love that you are taking the time to help this person. They need it.
Gets easier...keep plugging along. Also not sure which post it said at the end something like "I'd be happy not to be the AOR...." Yes, as time went on I learned, just out of being afraid of the consequences of helping, I'd rather just guide them into a Part D without actually doing it through my writing #. Especially when there's a mix of pain meds AND psychotropic meds involved. And that goes for no matter how long the list of meds is....only complaint I ever received came from a combo like this....just saying...many after that long ago complaint I just help guide...
Might be a reason no one else wanted to help. I've spent countless hours helping people like this and just "guided" with the only compensation I received after might be a referral.
You also didn't mention or maybe I missed it if LIS or low income was involved ... that could change everything. I've sent people directly to Magellan in Michigan and they helped take care of it all on the Rx side if this is the case, theres plenty other help
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