PDP Plans - Watch out

[insurance0707]

I've been running alot of prescriptions for my clients for 2009. Many, Many PDP plans have a 30 day fill at retail pharmacies. You can't get the 90 day fill. They're trying to get them to use mail order. It's showing up that they're not a pariticipating pharmacy on medicare's website, I've called the company directly and they actually do accept the pharmacies that are showing up but just in 30 day supplies. This might upset your clients so ask what pharmacy they use and check on this.

 

[policy doctor]

Don't know if this will start a future trend but who knows.

Aetna Teams With Costco



NU Online News Service, Nov. 4, 2008, 3:39 p.m. EST
.msocomanchor { BACKGROUND: infobackground}.msocomoff { DISPLAY: none}.msocomtxt { VISIBILITY: hidden}.msocomtxt { POSITION: absolute}.msocomtxt { TOP: -1000px}.msocomtxt { LEFT: -1000px}.msocomtxt { WIDTH: 33%}.msocomtxt { BACKGROUND: infobackground}.msocomtxt { COLOR: infotext}.msocomtxt { BORDER-TOP: threedlightshadow 1pt solid}.msocomtxt { BORDER-RIGHT: buttonshadow 2pt solid}.msocomtxt { BORDER-BOTTOM: buttonshadow 2pt solid}.msocomtxt { BORDER-LEFT: threedlightshadow 1pt solid}.msocomtxt { PADDING-RIGHT: 3pt; PADDING-LEFT: 3pt; PADDING-BOTTOM: 3pt; PADDING-TOP: 3pt}.msocomtxt { Z-INDEX: 100} /*vml*/ v\:* {behavior:url(#default#VML);} o\:* {behavior:url(#default#VML);} w10\:* {behavior:url(#default#VML);} .shape {behavior:url(#default#VML);} A managed care company is forming a Medicare Part D prescription drug plan alliance with a wholesale club chain.
Aetna Inc., Hartford, says it is selling a new Aetna Medicare Rx – Costco Plus Plan with Costco Wholesale Corp., Issaquah, Wash., in 17 states.
The states are Alaska, Arizona, California, Colorado, Florida, Hawaii, Idaho, Illinois, Michigan, Nevada, New Mexico, New York, Ohio, Oregon, Utah, Virginia and Washington.
Premiums for the no-deductible plan range from $50 to $70 a month.
In some cases, the plan will charge no co-payment for generic drugs bought at Costco. In other cases, the Costco co-payment will be $5.
The co-payment for generic drugs bought at network pharmacies other than Costco will be $10.
Costco will be helping to advertise the program in its member magazine as well as through in-store displays.

 

[MedSuppPro]

Of my 60 lookups so far. Watch formulary and provider drop offs.

This can also be true for hospitals. I have had claims for hospital ER were the Part D carrier is not a provider.

Also, VA people can incur costs for Rx's in hospital setting. I know some of you will fight me on this point. I will make Vets aware of this.

 

[GreenSky]

Of my 60 lookups so far. Watch formulary and provider drop offs.

This can also be true for hospitals. I have had claims for hospital ER were the Part D carrier is not a provider.

Also, VA people can incur costs for Rx's in hospital setting. I know some of you will fight me on this point. I will make Vets aware of this.

You need to explain please. I know that the ER is outpatient but I didn't know that medication provided there would be considered out of network by the Part D Carrier? I never thought of this so please educate me.

Rick

 

[MedSuppPro]

OK, I'll try!

Several of my clients have gone to the Hospital Emergency Room this year. They never where admitted to the hospital, yet, spent over a day there. Upon discharge, they later found a bill for all their PartD covered medications. Hospital was not a PartD provider and of course hospital pharmacy gladly charged their inflated prices. I did research and successfully got the hospital to eat the cost for one of my client's.

The reason they never were admitted was that the ER doctors didn't want to do the extra paper work in order to admit patient.

Medi website had a blurb on this dated effective Jan. 1, 2008. I don't have time to find original blurb. But, I feel it is worth noting the potential loss...

 

[GreenSky]

OK, I'll try!

Several of my clients have gone to the Hospital Emergency Room this year. They never where admitted to the hospital, yet, spent over a day there. Upon discharge, they later found a bill for all their PartD covered medications. Hospital was not a PartD provider and of course hospital pharmacy gladly charged their inflated prices. I did research and successfully got the hospital to eat the cost for one of my client's.

The reason they never were admitted was that the ER doctors didn't want to do the extra paper work in order to admit patient.

Medi website had a blurb on this dated effective Jan. 1, 2008. I don't have time to find original blurb. But, I feel it is worth noting the potential loss...

Interesting. Never looked at that aspect and really wouldn't know how to factor that in when presenting PDP plans.

Rick

 

[Joe Moore]

http://www.dads.state.tx.us/medicare/news/2006/hospitalcoverage.pdf

If this is correct seems that emergency room drugs are either a Part-B claim or an "out-of-network" Part-D claim.

This page sounds like CMS verbiage, but this is the only page posted. Not on CMS letterhead.

 

[MedSuppPro]

Thanks, Joe!

 

[Bob_The_Insurance_Guy]

Part D is for prescription medication. Any medication administered in the hospital does not fall under that category.

As for the mail order, it comes down to cost, plain and simple. Some medications have QL - quantity limits on them, and the medicare beneficiary MUST go to the physician to get a refill.

The maintenance medication - mostly generic - are the meds that are involved in the mail order pharmacy. Other than the initial order, what's the harm in getting your medication filled mail-order?

Should we all go to the Post Office everyday to pick up our mail, rather than have it delivered?

It's easier to keep a larger supply of medication in a warehouse or fulfillment center than in the back room of a CVS.



Am I missing something?

They are seniors, folks, not idiots.

 

[GreenSky]

Part D is for prescription medication. Any medication administered in the hospital does not fall under that category.

That's the "confusing" part. The ER is considered outpatient so why would any medication be paid under an inpatient benefit? Therefore, it would seem that Rx would be under Part D.

My head's going to explode.

Rick