Question: Assisting two clients moving from MAPD to Med Sup. One client on Novolin 70/30. Both were approved and was assisting them in enrolling through the Part d plan finder. After entering that drug, showed his estimated OOP at 3.5 k annually with the lowest cost Part D plan per the finder.
Currently pays around 850 annually with his MAPD plan.
The pharmacy he uses was also selected. Called pharmacy and stated I had no coverage. Cash price $170.00 month. Part D plan finder states with Rx plan 290/ month.
I then searched his current MAPD plan in the plan finder, which also stated his estimated OOP for prescription for 2016 was about 3,500, roughly the same.
Then had client call to ensure pricing for 2016, thinking this could be a bombshell in the making. They confirmed pricing for 2016 was 30.00 more annually than 2015. 45 month co-pay as it was a tier 3 preferred pharm drug at that pharmacy. His plan details 45.00 co-pay a month per vial but he actually pays 45.00/month for 7 vials....every month...and never has hit donut hole.
Got spooked by the whole matter and cancelled his policy. Was not going to put this guy in the trick bag on his insulin. But am quite confused.
Final thing, even called the proposed part d plan, explained what the pharmacy told me and all those jokers at the carrier can do is read what the Medicare plan finder estimates to them, though it was that informational breakdown that led me to call them in the first place.
Summary: Both his MAPD plan and proposed Part D plan on Medicare .gov show his drug costing him around 3500 OOP annually. Actual OOP, using Wal-Mart pharmacy, about 25% of that cost.
Can't confirm if that pricing would also be applicable under a Part D standalone, though the tier and co-pay show to be exactly the same.
Any veteran Part d guys/gals wanna take a stab at explaining why this is and where I can get more accurate trustworthy info than Medicare plan finder?
Profound thanks in advance for your collective insight.
Currently pays around 850 annually with his MAPD plan.
The pharmacy he uses was also selected. Called pharmacy and stated I had no coverage. Cash price $170.00 month. Part D plan finder states with Rx plan 290/ month.
I then searched his current MAPD plan in the plan finder, which also stated his estimated OOP for prescription for 2016 was about 3,500, roughly the same.
Then had client call to ensure pricing for 2016, thinking this could be a bombshell in the making. They confirmed pricing for 2016 was 30.00 more annually than 2015. 45 month co-pay as it was a tier 3 preferred pharm drug at that pharmacy. His plan details 45.00 co-pay a month per vial but he actually pays 45.00/month for 7 vials....every month...and never has hit donut hole.
Got spooked by the whole matter and cancelled his policy. Was not going to put this guy in the trick bag on his insulin. But am quite confused.
Final thing, even called the proposed part d plan, explained what the pharmacy told me and all those jokers at the carrier can do is read what the Medicare plan finder estimates to them, though it was that informational breakdown that led me to call them in the first place.
Summary: Both his MAPD plan and proposed Part D plan on Medicare .gov show his drug costing him around 3500 OOP annually. Actual OOP, using Wal-Mart pharmacy, about 25% of that cost.
Can't confirm if that pricing would also be applicable under a Part D standalone, though the tier and co-pay show to be exactly the same.
Any veteran Part d guys/gals wanna take a stab at explaining why this is and where I can get more accurate trustworthy info than Medicare plan finder?
Profound thanks in advance for your collective insight.