Community Chat

[LTT1]

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...

<iframe src="https://www.npr.org/player/embed/489790412/490037655" width="100%" height="290" framebord

The second link is a video of the text .

[Nightowlz]

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.

[terrier3]

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!

[Tinkrbl44]

Oh, gees ............   

[Coquille]

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. 

[LTT1]

@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.

[Moonchilde]

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.

[meem120]

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!!

[LTT1]

@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. 

[Moonchilde]

@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...