SilverScript Choice (PDP) 2020

[phaedruspress]

1. Go to Medicare.gov
2. Create an Account
3. Enter in your drugs
4. Use CVS and Walmart as the pharmacies
5. Sort based on "premium and drug cost"
6. Determine the least expensive plan.
7. IMO, if you are paying more than $500/year total, its well worth your time to look at more than 2 pharmacies.

Helpful hint: Most likely, your current SS Part D plan has a $100 deductible. Next year, there is a significant increase. Remember that if you get the Shingles shots at the pharmacy, it applies to the Part D deductible. If you still need the shots, get the 1st one done this month, so you can get the 2nd one in December-BEFORE you have the new, higher Part D deductible to meet.

Sorry, the "deductible" on the plans always has confused me. In the three years that I have had Medicare accompanied by a PDP I have never met the "deductible" and yet my drug costs have been minimal and always jive with the low cost indicated on the Medicare website as well as on the plan's website in this case my current Humana Walmart Rx Plan. If I switch over to the SilverScript plan if nothing goes sideways this coming year I will again not meet the "deductible" for the SilverScript plan just as I have not met the deductible for the Walmart plan but nonetheless I fully expect to only pay as mentioned the $1.00 monthly co pay for the only medication that I currently take without coming anywhere near the stated deductible. Currently without meeting the Walmart deductible I am only paying $1.70 a month for the same medication. Any insight too my confusion would be greatly appreciated.

 

[phaedruspress]

Generally no, unfortunately. Most if not all carriers will not spend their time speculating about exceptions and authorizations for non-members.

Remember, under Medicare rules, the new PDP must give you at least a one-month fill of any drugs which are non-formulary or under restrictions, which you are already taking, to give you time to get the necessary approvals.

Others' experience may differ, but I cannot remember the last time any of my clients called to fuss about any PDP (or Part D embedded in an MAPD) refusing to give them some drug their doc said they needed. It must be an infrequent problem. The only ones I can think of are beneficiaries seeking weird or unconventional medications. Armor Thyroid comes to mind.

>to get the necessary approvals.

Thanks for the info. Sorry for all of the questions but other then the physician should it be necessary conveying to the PDP that yes this individual needs this medication what are the other "necessary approvals" might there be that I have to obtain. TIA.

 

[Ronnie Carter]

Sorry, the "deductible" on the plans always has confused me. In the three years that I have had Medicare accompanied by a PDP I have never met the "deductible" and yet my drug costs have been minimal and always jive with the low cost indicated on the Medicare website as well as on the plan's website in this case my current Humana Walmart Rx Plan. If I switch over to the SilverScript plan if nothing goes sideways this coming year I will again not meet the "deductible" for the SilverScript plan just as I have not met the deductible for the Walmart plan but nonetheless I fully expect to only pay as mentioned the $1.00 monthly co pay for the only medication that I currently take without coming anywhere near the stated deductible. Currently without meeting the Walmart deductible I am only paying $1.70 a month for the same medication. Any insight too my confusion would be greatly appreciated.

In many plans, the deductible only applies to higher tier drugs, such as T3-T5. Is it possible that your particular meds are all lower tier? In that case, you would pay the lower of the copay or the plan-negotiated full price for the pharmacy involved, whichever is lower.

 

[Ronnie Carter]

>to get the necessary approvals.

Thanks for the info. Sorry for all of the questions but other then the physician should it be necessary conveying to the PDP that yes this individual needs this medication what are the other "necessary approvals" might there be that I have to obtain. TIA.

Not sure I understood your question, but the day your new PDP takes effect, you can start the process of applying for exceptions (tier, formulary, higher quantity limit, etc.) and/or getting necessary prior authorizations taken care of. Most if not all PDP plan sponsors will call or write you to help make the process go smoothly. As to which meds require PA, you can see that info in the plan's formulary or on the medicare.gov plan finder.

Good luck. I think you will find the whole ordeal is going to be less of a hullabaloo than you anticipate.

 

[StephanieCJ]

PA means your doctor needs to call in to the company and ask for a Prior Authorization for 12 months for that specific medicine and then he won’t have to do it for that medicine for the remainder of the year. Step Therapy is the thing to avoid.

 

[phaedruspress]

In many plans, the deductible only applies to higher tier drugs, such as T3-T5. Is it possible that your particular meds are all lower tier? In that case, you would pay the lower of the copay or the plan-negotiated full price for the pharmacy involved, whichever is lower.

>the deductible only applies to higher tier drugs, such as T3-T5

Ahh! Thanks so much. That explains it. It was just a confusing sticking point for me and now I understand what the deductible actually means. All of my prescription drugs thankfully for the past three years have all been either tier one or two which explains why they have been inexpensive and the deductible never had to kick in.

 

[phaedruspress]

Not sure I understood your question, but the day your new PDP takes effect, you can start the process of applying for exceptions (tier, formulary, higher quantity limit, etc.) and/or getting necessary prior authorizations taken care of. Most if not all PDP plan sponsors will call or write you to help make the process go smoothly. As to which meds require PA, you can see that info in the plan's formulary or on the medicare.gov plan finder.

Good luck. I think you will find the whole ordeal is going to be less of a hullabaloo than you anticipate.

Thank you for the explanation.

 

[phaedruspress]

PA means your doctor needs to call in to the company and ask for a Prior Authorization for 12 months for that specific medicine and then he won’t have to do it for that medicine for the remainder of the year. Step Therapy is the thing to avoid.

Thank you for the explanation.

>Step Therapy is the thing to avoid

What fresh hell is that!

Step therapy - Wikipedia

 

[LostDollar]

For op,

Here is a site I like to use for overview information about PDP plans.

Find a 2020 KS Medicare Part D Plan

(note, they draw their info from CMS, so it won't be any more accurate than CMS data and will lag behind any corrections made on the CMS site.)

Not knowing your state, I used KS. Scanning down the plan list I see the humana walmart, humana premier, and silverscript choice plans all exclude T1 and T2 drugs from the deductible (in KS anyway).

That means that if your meds are all T1 or T2, you will just pay the plan's copay for those throughout the year, and deductible procedures and computations will never enter into your medication purchases.

 

[phaedruspress]

For op,

Here is a site I like to use for overview information about PDP plans.

Find a 2020 KS Medicare Part D Plan

(note, they draw their info from CMS, so it won't be any more accurate than CMS data and will lag behind any corrections made on the CMS site.)

Not knowing your state, I used KS. Scanning down the plan list I see the humana walmart, humana premier, and silverscript choice plans all exclude T1 and T2 drugs from the deductible (in KS anyway).

That means that if your meds are all T1 or T2, you will just pay the plan's copay for those throughout the year, and deductible procedures and computations will never enter into your medication purchases.

Thank you very much for the info. Nevada by the way.

>That means that if your meds are all T1 or T2, you will just pay the plan's copay for those throughout the year, and deductible procedures and computations will never enter into your medication purchases

Yes. All of my meds for the past three years have been either T1 or T2. I just was not either able to understand or grasp the fact that the "deductible" that I always see with these plans did not enter into the equation because of the tier level of the medication that I was using. Thanks again and to everyone else for taking the time to reply.