Wellness

[I am still oxox]

I have decided on the Medicare plan and now I need to figure out the prescription stuff. Unfortunately I take 3 tier 3 medication with no generic out there. I have priced out many plans through an agent, she even through Good Scripts or Canadian pharmacy the prices are crazy.

I have to ask the doc the prescribed them if there are alternatives out there that are Tier 1 or 2.

This is driving me nuts, the meds I take work but I can not afford 700 quartley to keep them.

What to do what to do.

Thanks for all the help you have been to me

[jlkz]

@I am still oxox

Can your doctor change one of them or negotiate for you on the most expensive medication(s) with the selected drug plan ?

My cousin was able to get a reduced price from her drug company because the bipolar medication she needed was too expensive for her limited means.  Perhaps you can do the same ?

Good luck with this frustrating scenario. It is so maddening when you hear about the obscene profits some of the largest health insurers make.

[BirkiLady]

@I am still oxox  What are you currently doing for your meds? Usually they are less expensive on Medicare Part D (after retirement) even if they are a Tier 3. I use a local pharmacy; not a mail-order for mine. Remember, your insurance will be much less than what you are currently paying while working. All in all, I think you'll come out ahead. Go over all the numbers again. Best wishes.

[software]

See if there are any assistance organizations specifically for your diagnosis

Also contact the drug company directly, they may have a program or direct you to one.

There are alternatives, don't give up.

[I am still oxox]

@BirkiLady

I am covered on DH's plan  and pharmacy is covered, my tier 3 meds are $80 for 90 days, tier 2 is $60 for 90 days and so on.

They are not less on part D they are considerably like 3 times higher on any of the medicare plans.

Dh will be droping me from his plan and the cost will be higher at the  frot end but lower on the back end no co-pay or 15% co insurance to pay. 

Right now I am going through some issues and the treatment is 2000 out of pocket per session, with the plan I have the savings will be right there

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@BirkiLady wrote:

@I am still oxox  What are you currently doing for your meds? Usually they are less expensive on Medicare Part D (after retirement) even if they are a Tier 3. I use a local pharmacy; not a mail-order for mine. Remember, your insurance will be much less than what you are currently paying while working. All in all, I think you'll come out ahead. Go over all the numbers again. Best wishes.

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[I am still oxox]

@software Thank you and since DH is still working, we can not get EPIC and  I have been on these meds for years I have used all of the lower co pay options that were out there.

I am confident that between, me, my agent and my doc we can find a solution to the issue.

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@software wrote:

See if there are any assistance organizations specifically for your diagnosis

Also contact the drug company directly, they may have a program or direct you to one.

There are alternatives, don't give up.

---

[BirkiLady]

@I am still oxox  Those infusions should be covered once you are on Medicare. I was on Disability for many years before needing infusions so I'm not exactly sure how that works, but I'm confident they will be covered. My pre-existing conditions were covered without any problems. 

I'm so sorry to hear you are having serious health issues. Hope the infusions provide some relief. 

Sorry I'm unable to give any concrete advice on your individual Part D. CARMIE may be able to answer your question. She's the genius on this subject. 

[kittymomNC]

I wish I had some good advice for you, other than the old standby... patience.  You are doing the right thing by doing research and working with someone who hopefully understands this.  If you've chosen your Medicare supplement, then you probably know that those plans are standardized, i.e., Plan F is Plan F (or whichever plan you choose) no matter which insurance company you buy it from.  The prices may be different, the service may be better or worse, but the coverage is the same.

Unfortunately, Part D plans for prescriptions are not standardized, as I'm sure you've discovered.  Although I'm glad we at least have coverage as seniors (years ago there was no prescription coverage to speak of), I've often said that whoever came up with the way the Part D plans work must surely have been on their own kind of "drugs" when they did it!  Everything is different from company to company and plan to plan, drug pricing, co-pays, premiums, everything - and it almost takes a genius to figure out what is best for each individual. 

And be mindful that insurers can change things, even in the middle of a plan year.  I have one med I was paying for with a $5.00 co-pay for 90 days, and one day I picked it up, and they said "that will be $32.50"... needless to say, I stopped in my tracks.  After getting them to check and make sure it went through my plan,  I discovered that the insurer had gone up over 600%, yes, 600% on that medication, in the middle of the plan year.   After a number of phone calls (including finding out that I could get that exact prescription from my local big box store pharmacy for $10.00 cash), and making it EXTREMELY clear what I thought about the situation, they did an "exception" and told me I could get it for $7.50 co-pay for one year.  The end of that year is in October, so I either have to ask for it to be extended (and they may not do it), pay the 600% increase, or change plans when I can... the big box store price has gone up to $22.00.  

I don't mean to scare you or make you more confused.  I just want you and others who may not be aware of this, to know what can happen.  I've been happy with the plan I have and still am, except for this (which could happen with any company). I've had co-pays change before, but not 600%.  The Part D plans should have been set up so that 50 million people on Medicare could negotiate prices, that's a lot of negotiating power.  But they didn't do it that way, they set it up on some kind of discount basis which I still don't understand and probably never will.  Congress could change it by standardizing the plans and giving us the negotiating power for pricing, but they don't seem to be interested.

Keep at it... I hope you will find a good plan that will work for you!

[Tinkrbl44]

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@I am still oxox wrote:

I have decided on the Medicare plan and now I need to figure out the prescription stuff. Unfortunately I take 3 tier 3 medication with no generic out there. I have priced out many plans through an agent, she even through Good Scripts or Canadian pharmacy the prices are crazy.

I have to ask the doc the prescribed them if there are alternatives out there that are Tier 1 or 2.

This is driving me nuts, the meds I take work but I can not afford 700 quartley to keep them.

What to do what to do.

Thanks for all the help you have been to me

---

@I am still oxox

 I'm thinking this is a continuation of what Medicare pkg to select?   There were references to local SHIP people who can help you .... why not call them and pick their brain for prescription plan comparisons.

If there's no generic for some of your meds, maybe there is something similar that could be prescribed?   

There are also various foundations etc that help out .....  I would google "financial assistance for ______ " and search one drug at a time, and see where that takes you.  

[m0rgan]

@I am still oxox  I am not sure if good scripts is like goodrx.com or not.  They seem to have good prices.