Part D Notes 2025

[Truce]

Wellcare has taken a few meds that were tier 3 last year and switched to a tier 2. Here's two I did today where members were using Goodrx/Cost Plus and now can just fill using their Value Script when auto renewing. No, you will not be paid for sharing this information with your clients.

Ezetimibe
risedronate sodium

 

[kgmom219]

Fenofibrate is still hated by everyone. Use Good RX

 

[kgmom219]

Leqvio is a Part B option for Repatha.

Fabulous savings.

 

[annon123]

Fenofibrate is still hated by everyone. Use Good RX

Singlecare is another decent coupon site. Around here every pharmacy accepts it.

 

[somarco]

Myrbetriq Alternatives Compared - Drugs.com

Compare Myrbetriq head-to-head with other drugs for uses, ratings, cost, side effects and interactions.

www.drugs.com

 

[somarco]

Not one carrier will cover basaglar

https://www.singlecare.com/prescription/basaglar-kwikpen?q=Basaglar%20Kwikpen

There are quite a few meds not on any formulary for 2025 . . . so you have to get creative if you want to help your prospect/client


Basaglar and Lantus contain the same active drug: insulin glargine. Basaglar is called a follow-on drug to Lantus. This means it's very similar to Lantus, which is a biologic drug.

Insulin glargine Alternatives Compared - Drugs.com

Compare Insulin Glargine head-to-head with other drugs for uses, ratings, cost, side effects and interactions.

www.drugs.com

 

[goillini52]

Leqvio is a Part B option for Repatha.

Fabulous savings.

My wife uses Repatha and it's covered under Part D. She self injects every 2 weeks.

 

[annon123]

There are quite a few meds not on any formulary for 2025 . .

When I checked formulary size around here it varies a fair bit too. Looking at the number of drugs in each tier is pretty different too between some of the plans in some cases too so it isn't just a drop in size but tier changes of drugs and tier size. Some some drugs have been "uptiered" (Humana here is sending letters to clients any of their drugs as been moved to a more expensive tier).

This is going to burn some clients (not even thinking about the 70% or whatever it is whom never check their D's each year). And those doing it themselves who don't look at formulary size may be shocked when a drug prescribed (not on their current list of meds they are taking) is not on the formulary because the formulary for the plan they have is small. I talk to people about this issue of no time machine to see what the future will bring and maybe it might be worth adding formulary size into the issues that they are going to weight in their decision - not just price for what they are taking now (I make the same comment with relevant info like medical underwriting in the context of OM vs MAPs too).

Here is what the situation looks like locally (sorted by formulary size). Yeah I know... Idle curiosity killed the cat. But have excel will travel. LOL



Actually what I think clients need to know is that, in my state anyway (your mileage may vary), in addition to current projected cost based on drugs they are taking and which is cheapest for them: they need to think about the size of the formulary, along with the size of tiers 1& 2 vs more expensive tiers, whether or not they are relatively healthy, whether or not they think anything will change in the future, and whether or not they are willing to gamble on what will happen in the future. Depending on their answers to these things then deciding how they will weigh in these other factors in their final decision rather than just going on total current cost for them.

 

[somarco]

I don't recall having an issue with PA (prior authorization) drugs but I have to wonder if the Part D plans will start to crack down on PA meds and deny them, even if they are on the formulary.

Here is one example . . . Cosentyx is tier 5 (some plans) and PA is required. There are other meds, less expensive and possibly just as effective

Cosentyx Alternatives Compared - Drugs.com

Compare Cosentyx head-to-head with other drugs for uses, ratings, cost, side effects and interactions.

www.drugs.com

Some of the newer brand name drugs are less effective than older generic drugs.

Opinion | Old Drugs, New Tricks: The Power of Medication Repurposing

COVID highlighted the untapped potential of existing treatments

www.medpagetoday.com

 

[annon123]

Some of the newer brand name drugs are less effective than older generic drugs.

Hopefully a medical provider will work with the patient with respect to drugs and what they can afford that is effective. Some of them, I have found with personal experience, are resistant to having a patient make that kind of request/suggestion unfortunately and/or want to go with the newest, latest greatest... Even generics can vary in cost. I am personally taking one that can range from about $18 - 34 depending on who manufactures it. I finally got the drug identification number of the specific one that is cheapest and call around in network pharmas to find that specific one if my usual pharma (they commented they stock which ever generic they can get at the time of their order) is quoting me a higher price due to it being a different generic for the same brand name.

One catch with generics is that they are not totally identical. They can have about a 20% variation in the active ingredient(s) and still be allowed to be called the generic (although usually that difference is smaller). Sometimes patients have side effects with one generic and not another or not with the brand but do with the genetic. Also because of the differences sometimes one generic works better than others or the brand name works better than the generic. The article below goes into more detail about this (notice the weasel word "largely").

Do generic drugs compromise on quality? - Harvard Health

Generic drug quality is sometimes questioned, but studies largely show that these medications are equivalent in quality to their brand-name counterparts and are less expensive....

www.health.harvard.edu