Who is more likely to get Oxycontin approved? (in GA)

[Will305]

I have a client from GA losing employer plan soon, i've been working on this and anticipating for months but he is in very very bad shape, he takes several brand name drugs (10+ in general), takes BOTH oxycodone and oxycontin. he has a bunch of diff. conditions, several Drs, pain management dr. etc. This person needs a SUPP 100%, now he is leaning towards a CSNP, a mistake!. to my surprise even CSNP are looking pretty bad for next year.
Long story short has anyone had luck with any carrier approving oxycontin? ideally Part D, I must convince this guy he MUST get a Supp. This is in GA btw.
Interestingly oxycontin is covered in FL no wonder we are the rehab facilities capital. if it's not in the formulary it doesn't count towards the $2k max. it's $1,400mo.

 

[rmhaire]

I have a client from GA losing employer plan soon, i've been working on this and anticipating for months but he is in very very bad shape, he takes several brand name drugs (10+ in general), takes BOTH oxycodone and oxycontin. he has a bunch of diff. conditions, several Drs, pain management dr. etc. This person needs a SUPP 100%, now he is leaning towards a CSNP, a mistake!. to my surprise even CSNP are looking pretty bad for next year.
Long story short has anyone had luck with any carrier approving oxycontin? ideally Part D, I must convince this guy he MUST get a Supp. This is in GA btw.
Interestingly oxycontin is covered in FL no wonder we are the rehab facilities capital. if it's not in the formulary it doesn't count towards the $2k max. it's $1,400mo.

Why is he losing his employer plan? Is he about to T65 or has he been working past 65?

And where is he with parts A & B?

 

[somarco]

14 PDP in Georgia . . . none have Oxycontin on the formulary

 

[Will305]

Why is he losing his employer plan? Is he about to T65 or has he been working past 65?

And where is he with parts A & B?

not t65, Wife is losing it. he will be open enrollment and actually qualifies for a Plan F. they are with BCBS and he's only paying $75 for the oxycontin that's hard to beat. there's no part D nor MAPD that has it in the formulary just wanted to get some feedback to see if anyone has clients with approved Oxys.

 

[somarco]

I doubt you will find anyone who will approve a Medigap application if that is what you are asking.

Involuntary loss of EGH should create an SEP/GI situation.

The only way for him to be eligible for the F plan is if he turned 65 before 1/1 2020.

Even if he is eligible for F there are few carriers still offering it and G is a much better value.

I must convince this guy he MUST get a Supp

What is this about?

 

[Will305]

I doubt you will find anyone who will approve a Medigap application if that is what you are asking.

Involuntary loss of EGH should create an SEP/GI situation.

The only way for him to be eligible for the F plan is if he turned 65 before 1/1 2020.

Even if he is eligible for F there are few carriers still offering it and G is a much better value.


What is this about?

best for him, that's what i meant. he's leaning towards MAPD. i can do both just looking out for his best interest.

 

[myinsurebiz]

not t65, Wife is losing it. he will be open enrollment and actually qualifies for a Plan F. they are with BCBS and he's only paying $75 for the oxycontin that's hard to beat. there's no part D nor MAPD that has it in the formulary just wanted to get some feedback to see if anyone has clients with approved Oxys.

jUST USE A dISCOUNT rx cARD

 

[Special Agent]

I have a client from GA losing employer plan soon, i've been working on this and anticipating for months but he is in very very bad shape, he takes several brand name drugs (10+ in general), takes BOTH oxycodone and oxycontin. he has a bunch of diff. conditions, several Drs, pain management dr. etc. This person needs a SUPP 100%, now he is leaning towards a CSNP, a mistake!. to my surprise even CSNP are looking pretty bad for next year.
Long story short has anyone had luck with any carrier approving oxycontin? ideally Part D, I must convince this guy he MUST get a Supp. This is in GA btw.
Interestingly oxycontin is covered in FL no wonder we are the rehab facilities capital. if it's not in the formulary it doesn't count towards the $2k max. it's $1,400mo.

He can use goodrx.BTW if you do help him with PDP and he intends to use it make sure you warn him about the 7 day supply on first fill without prior authorization because the opioid addicts freak out if they can't get there supply and they will call you.

 

[Will305]

He can use goodrx.BTW if you do help him with PDP and he intends to use it make sure you warn him about the 7 day supply on first fill without prior authorization because the opioid addicts freak out if they can't get there supply and they will call you.

GoodRx isn’t much help same price as with any Medicare Plan. Thanks for the 7day supply info though. A Oxy PAP doesn’t allow Medicare Plans, although most brand name drugs requirements say the same but I have seen and helped a lot of people with PAP approved with MAPDs and PDPs.

 

[annon123]

GoodRx isn’t much help same price as with any Medicare Plan. Thanks for the 7day supply info though. A Oxy PAP doesn’t allow Medicare Plans, although most brand name drugs requirements say the same but I have seen and helped a lot of people with PAP approved with MAPDs and PDPs.

SingleCare is another coupon/discount program that for some drugs beats GoodRx on price, sometimes by a lot. It has various oxy drug coupons. Theoretically (don't know of anyone who has tried it and how much of a hassle it was) if the person turns in the proof he paid cash (and didn't use their D plan) for an rx'ed drug the D plans are supposed to include that in the deductible paid.