topic Re: Formulary Rx List of Dropped Medicines npr.com in Community Chat

Formulary Rx List of Dropped Medicines npr.com

LTT1 — Tue, 16 Aug 2016 17:46:17 GMT

Will your prescription drugs be covered next year

The above is a link to an article published by the nor.

http://www.npr.org/sections/health-shots/2016/08/15/489790412/will-your-prescription-meds-be-covered-next-year-better-check?utm_source=facebook.com&utm_medium=social&utm_campaign=morningedition&utm_term=nprnews&utm_content=20160815

The second link is a video of the text .

Re: Formulary Rx List of Dropped Medicines npr.com

Nightowlz — Tue, 16 Aug 2016 17:58:09 GMT

We use the CVS Caremark. Looks like they have a very long list. Glad I don't take any of them. All I take is Np Thyroid. DH does not take anything. Kind of stuck in between a rock & a hard place with them telling you what they will pay for or not.

Re: Formulary Rx List of Dropped Medicines npr.com

terrier3 — Tue, 16 Aug 2016 18:11:11 GMT

Different insurance companies have their own formularies too.

As someone who has worked in HI, I could never figure out how people could determine what drugs they MIGHT need later on.

Cancer infusions and other drugs are VERY expensive and there is a great disparity among insurers. It's not something most people can "plan" on having to receive!

Re: Formulary Rx List of Dropped Medicines npr.com

Tinkrbl44 — Tue, 16 Aug 2016 18:14:52 GMT

Oh, gees ............

Re: Formulary Rx List of Dropped Medicines npr.com

Coquille — Tue, 16 Aug 2016 18:24:34 GMT

I found that out last week when I went to refill a script for my IBS. My co pay with my insurance was $15.00. Without insurance the cost would have been $60.00 (2 months worth). Now, the insurance dropped the medication and I was told the cost now is $863.00. My doctor has put in an appeal so hopefully they will pay for it at least one more time. I'm not counting on it. I go on Medicare in November so, I doubt I can get it with Part D. Good luck everyone.

Re: Formulary Rx List of Dropped Medicines npr.com

LTT1 — Tue, 16 Aug 2016 18:59:12 GMT

@Coquille@Tinkrbl44@terrier3@terrier3@Nightowlz

I guess everyone knows what they take/what they would rather take, etc.

In the past, we always had insurance thru our company. Now, I'm in a holding pattern for interim months before Medicare starts.

Our policy is high deductible; I'm more interested now in the formularies, etc.

Re: Formulary Rx List of Dropped Medicines npr.com

Moonchilde — Tue, 16 Aug 2016 21:06:32 GMT

I saw this last night and almost posted it.

Something I don't understand and am going to call

Silverscript about (Silverscript is the Medicare Part D of Caremark) - several months ago, one of my medications was denied by Silverscript as not being covered.

On the list this thread is about, the *generic* of the medication, *which is what I was taking* is listed as an alternative option, i.e. okay to prescribe. So, I'm wondering if that was a boo-boo on their part.

Two other *branded* medications, which I take generics of, are not covered, but I have not been refused the generics, which are on the list as "options." I would presume that the generic options listed to the right of newly-dropped drugs ARE covered, yes? Or are they saying that none of them, not even the generics, are covered?

I think for that one med I was denied it was an error. I haven't followed up to this point because it wasn't something I will suffer without, but I will call because I want to ask about generics after this new list.

EDIT: After lengthy investigation, I discovered the reason my one Rx was refused is because *only for those 65 and over* they need an MD note. It IS covered, they just need to hear from the doctor because I'm over 65. It's a muscle relaxant, so I guess I can see their point. But not something I would get upset about not having, either.

And Yes, the drugs listed as generic options ARE covered, in case anyone doubted or was confused, which is why the other two of mine on the list are no problem as I' e always taken the generics.

Re: Formulary Rx List of Dropped Medicines npr.com

meem120 — Tue, 16 Aug 2016 20:43:04 GMT

Youre part D RX coverage does not have to be the same company as you have your supplemental insurance. Part D is a Medicare program, but they farm it out to the insurance companies. Each insurance company has there own formulary, its not just one and it doesnt go by what drug store you have your RX filled. I would check around the insurance companies for the best prices on your individual prescriptions. Of course no one knows what the future holds, but youre not locked in. You can change every year if you need to. For instance my most expensive Rx is Celebrex. AARP had the cheapest price for that so thats who I went with . My other prescriptions are all just $4.00 You have to look around, there was over a $100 diffrence from one insurance company to another per month for Celebrex and thats pretty big!!

Re: Formulary Rx List of Dropped Medicines npr.com

LTT1 — Tue, 16 Aug 2016 21:22:08 GMT

@meem120@Moonchilde@Coquille@Tinkrbl44

I will add my confusion to our list!

The insurance I have (for a few months) is a Cigna plan. When I looked one of mine up (Nexium) I would have to pay $1000 for. 90 day Rx ... NOTHIN DOIN! Lol It is so costly because it is in a certain tier.

Then, there are second tier options, covered at a lower %.

It wouldn't be applicable in my case because the plan we decided on has a high deductible.

Re: Formulary Rx List of Dropped Medicines npr.com

Moonchilde — Tue, 16 Aug 2016 21:35:46 GMT

@LTT1

You can buy Nexium at Costco, Walmart, etc.

I buy Zyrtec there. I could get Zyrtec and Flonase by RX but both are now OTC like Nexium, so it's just easier for me to do that.

LOL, I just got a letter (I get them periodically) reminding me that if I got the 90-day mail order supply, I could save (gasp!) a whole 16% a month! For me that would be about $3. Not highly motivating...

Re: Formulary Rx List of Dropped Medicines npr.com

terrier3 — Tue, 16 Aug 2016 21:43:41 GMT

@meem120 wrote:
Youre part D RX coverage does not have to be the same company as you have your supplemental insurance. Part D is a Medicare program, but they farm it out to the insurance companies. Each insurance company has there own formulary, its not just one and it doesnt go by what drug store you have your RX filled. I would check around the insurance companies for the best prices on your individual prescriptions. Of course no one knows what the future holds, but youre not locked in. You can change every year if you need to. For instance my most expensive Rx is Celebrex. AARP had the cheapest price for that so thats who I went with . My other prescriptions are all just $4.00 You have to look around, there was over a $100 diffrence from one insurance company to another per month for Celebrex and thats pretty big!!

Remember too that just as you can change Part D insurers, the insurance companies can also change their formulary - and they don't have to waut for enrollment season to change (same with the provider list too - they can change at will).

Re: Formulary Rx List of Dropped Medicines npr.com

terrier3 — Tue, 16 Aug 2016 21:45:11 GMT

@LTT1 wrote:
@meem120 @Moonchilde @Coquille @Tinkrbl44

I will add my confusion to our list!
The insurance I have (for a few months) is a Cigna plan. When I looked one of mine up (Nexium) I would have to pay $1000 for. 90 day Rx ... NOTHIN DOIN! Lol It is so costly because it is in a certain tier.
Then, there are second tier options, covered at a lower %.

It wouldn't be applicable in my case because the plan we decided on has a high deductible.

You will be paying out of pocket for your meds?

Re: Formulary Rx List of Dropped Medicines npr.com

LTT1 — Tue, 16 Aug 2016 23:25:43 GMT

@terrier3

Yes, this insurance lumps the deductible for Rx s in with the medical deductible. But I will check this again.

I just paid for a proton-pump med (like Nexium) today thru a company called "blinkhealth." The cost was just an introductory deal, I'm sure. Mere pennies.Have not gone to the pharmacy to pick it up yet, so we shall see.

I won't enjoy playing "pill-tag" all over town though if it changes drastically each time I order. : )

Re: Formulary Rx List of Dropped Medicines npr.com

Gooday — Wed, 17 Aug 2016 00:25:28 GMT

An interesting news article today. Aetna lost 480 million dollars on the ACA. It will be available in 5 states (?). This is the 4th big insurance company to leave the program.

I said over 2 years ago that this will fold like a house of cards. We shall see. Stay tuned folks.

Re: Formulary Rx List of Dropped Medicines npr.com

goldensrbest — Wed, 17 Aug 2016 18:52:41 GMT

@terrier3, i read that you said you worked in the insurance business, i have a question, i turn 65 this december, i simpy do not even begain to understand medicare, i have read on line, but it is so confussingto me, where do i start first? Should i make a appointment with SS office? All this having to buy insuance to cover medications, and then having to buy insurace to cover hospital stays,and what not, it is going to be so much more than my obama care i have now, i live on ss.

Re: Formulary Rx List of Dropped Medicines npr.com

meem120 — Wed, 17 Aug 2016 19:03:01 GMT

I would suggest you make an appt with SS. Medicare is a good program when you have a supplemental insurance. It's really not as complicated as you think. Just take it one step at a time. My Medicare, supplemental AARP, and part D prescription plan cost me around $325 a month. But depending on income you may be able to get help. It's worth a trip to the SS office

Re: Formulary Rx List of Dropped Medicines npr.com

Lila Belle — Fri, 19 Aug 2016 01:55:28 GMT

@GoodayGooday wrote:
An interesting news article today. AetnaAetna lost 480 million dollars on the ACAACA. It will be available in 5 states (?). This is the 4th4th big insurance company to leave the program.
I said over 2 years ago that this will fold like a house of cards. We shall see. Stay tuned folks.

``````````````````````````````````````````````````````````````````````````````````````

Aetna has been PO'D ever since their Humana merger went bust. They wanted a monopoly deal like the cable companies now have where they corner the market in chunks.

Re: Formulary Rx List of Dropped Medicines npr.com

151949 — Fri, 19 Aug 2016 02:36:27 GMT

The formularies are set by the insurance companies NOT by medicare - same with what tier a drug is in - set by the insurance company, not by medicare.

Re: Formulary Rx List of Dropped Medicines npr.com

151949 — Fri, 19 Aug 2016 02:38:33 GMT

@Coquille wrote:
I found that out last week when I went to refill a script for my IBS. My co pay with my insurance was $15.00. Without insurance the cost would have been $60.00 (2 months worth). Now, the insurance dropped the medication and I was told the cost now is $863.00. My doctor has put in an appeal so hopefully they will pay for it at least one more time. I'm not counting on it. I go on Medicare in November so, I doubt I can get it with Part D. Good luck everyone.

It seems easy to figure this out -- if the cost without insurance is $60 - then just buy it out of pocket without insurance.

Re: Formulary Rx List of Dropped Medicines npr.com

Moonchilde — Fri, 19 Aug 2016 02:58:59 GMT

@Lila Belle wrote:
@GoodayGooday wrote:
An interesting news article today. AetnaAetna lost 480 million dollars on the ACAACA. It will be available in 5 states (?). This is the 4th4th big insurance company to leave the program.
I said over 2 years ago that this will fold like a house of cards. We shall see. Stay tuned folks.
``````````````````````````````````````````````````````````````````````````````````````
Aetna has been PO'D ever since their Humana merger went bust. They wanted a monopoly deal like the cable companies now have where they corner the market in chunks.

That is the crux of their pull-out.