I’ll keep it real brief today. So far this year, most reviews on our Part D ratings site – MedicareDrugPlans.com – are written by frustrated and angry American seniors who have discovered they will be paying much more money for prescription drugs in 2016. I, happily, concede that there are millions of satisfied seniors who are going about their year with good Part D coverage. For instance, so far my mom is happy (but I helped her pick her plan). Let’s face it: millions of others are not happy and they are rightfully venting. Let us know about your experiences with Medicare Part D this year, by rating and reviewing your plans. Note: We want to hear good reviews (we know some of you are happy with your plans) to help people find the best plans!
For an overview of the venting, check out the reviews below.
Plan: Cigna-HealthSpring Rx Secure – California
Review: This plan was $39 in 2015…increased to $77…I received no notification of the increase, and did not realize it had changed until I received my Jan credit card statement by then it was too late to make a change….I would absolutely not choose this company in the future. Major rip off for senior citizens!
Multiple Medicare Part D Mayhem
Plan: Humana Walmart Rx Plan – South Carolina
Review: Explanations of coverage terrible. They challenged our first two prescriptions although we had been taking them already. Looks like they almost automatically reject prescriptions and force you to get exceptions — wear you down. So far it’s everything bad you’ve heard about insurance companies. And the Wal-Mart guy (pharmacist)? I asked one question: ‘Which of these are tier one and two”. His ‘helpful” response. “I haven’t the faintest idea”
Drug Cost Smack
Plan: Blue MedicareRx Value Plus
Review: i enrolled and used plan for 4 months and then they bumped the cost of an in-office infusion therapy from $40 dollars per treatment, (every 8 weeks), to $862!!!!!!! No notification. Dropped them like a rock and off to MEDEX with separate plan for prescriptions.
Tagged with: Blue MedicareRx Value Plus, Cigna-HealthSpring Rx Secure, Humana Walmart Rx Plan, Medicare Part D, medicaredrugplans.com
In this post, we’ll give you some snapshots of consumer frustration, pulled from www.MedicareDrugPlans.com (a website operated by PharmacyChecker.com), about the problem of medications getting dropped from Part D Plans and tell you what is and is not actually permissible. I believe this practice is well characterized by the phrase “bait and switch.” Just listen to Riley from California talk about Blue Shield Medicare Enhanced Plan:
“Keep changing the drugs in the formulary. Just get stabilized on a drug and they drop it from the formulary or charge high tier prices. Then you start on a different drug fine one that works then it is no long covered in next formulary. There is no concern for the patient doesn’t matter to them if you wind in the emergency room at a cost of many thousands of dollars and patient’s pain and discomfort. It is not their problem the medical coverage has to pay for it and the drug coverage have saved themselves some money at the cost of medical coverage, medicare and the patient.”
Before choosing a plan, most experts encourage people to research plan premium and deductible costs, pharmacy networks, gap coverage, and – most importantly – which drugs are covered in a plan’s formulary. The beauty of the government’s Medicare Plan Finder is that you get to actually type in your medications and find plans that cover those drugs. So imagine doing just that: you look on the government’s site and find a plan that covers the three medications you take. You’ve taken THE BAIT and enroll in that plan. Come January all is well, your costs are manageable and you pat yourself on the back for a research job well done. Then in March – THE SWITCH – you find out that the brand name drug prescribed by your doctor, which has worked well for you for years, will no longer be covered and you either have to take an alternative drug that is covered or pay for the drug as an out-of-pocket cost.
Is this type of bait and switch legal? Yes. After reviewing the regulation, 42 CFR 423.120, the law is clear that Part D plan sponsors can take a covered drug off its formulary. There are some caveats but I don’t believe they compensate for how unfair these formulary changes are. The plan must either give you 60 days notification before the formulary change goes into effect or if you go to the pharmacy for a refill the plan must cover the drug with a 60-day supply. In other words, they need to warn you about the bait and switch to give you time to figure out your next move.
Some enrollees seem to have had good experiences with a plan and then everything just tanks. We learn from one Michigan resident about an experience using the Cigna-HealthSpring Rx Secure plan
“After 5 years in plan they dropped coverage on 3 of my 5 scripts, no value now, cheaper to buy all on my own”
Some consumers gave greater details about the costs incurred due to these bait and switch practices. Here’s what one Floridian said about AARP MedicareRx Saver Plus:
“They dropped an important Blood Pressure medication (Micardis) for 2015 as well as others. Out of pocket cost went from 2013 -$60.00, then in 2014 $120.00 now in 2015 over $545.00 for 90 day supplies of Micardis through Optum RX their online med source. Too late for me, will look for a better Part D source come next year.”
Our friend from Florida could look for a new plan for 2016 but what guarantees to they have that the same bait and switch won’t occur?
Is there an upshot here? You do receive notification with 60 days to figure out what to do. The notification that you’ll receive about your drug being dropped must contain, to quote from the federal regulation, “alternative drugs in the same therapeutic category.” It might seem like small consolation if the medication you’ve been using works but do not rule out a pharmaceutical alternative, probably a lesser expensive generic, IF your prescriber believes it will work just as well.
If you and your healthcare provider decide you should take the drug that was dropped and not a pharmaceutical alternative, and the costs are too high domestically, then you might consider an international online pharmacy verified by PharmacyChecker.com. Brand name drugs are often 90% lower outside the U.S. when purchased from a verified online pharmacy.
Finally, there is an appeal process that you and your healthcare provider can use if you believe your plan isn’t covering the medications you need – including ones that they drop! I’ve read that this process can be a serious nightmare. But this is a blog post unto itself and I plan on covering this topic in the weeks to come.
Tagged with: bait and switch, consumer review, formulary changes, Medicare Part D, medicaredrugplans.com
Since open enrollment began two days ago, Medicare beneficiaries all over the country have been looking for new Medicare Part D plans. In fact, based on our analysis of recent Part D Reviews on MedicareDrugPlans.com, you’d think most enrollees were looking for new plans! Of the past 50 reviews on the site, this is what we found:
- 44% had customer service issues, including unresponsive service, rude representatives, and billing and enrollment errors.
- 42% complained about mail order issues, such as shipments taking too long, poor packaging and instructions, and poor website experiences.
- 30% had problems prescribed drugs not being covered, inaccurate pricing, or coverage refusal after requesting authorization.
While we can’t say much about how to prevent dealing with mail order pharmacy or customer service issues, we know that you have the power to tackle formulary problems. Just so we’re clear, the way to find out which plans cover the drugs you need is at the government’s site, Medicare.gov – not on MedicareDrugPlans.com. MedicareDrugPlans.com serves as a listening board for what you need to look out for when you pick your plan, and is meant to be a supplement to the government’s site, so we recommend using both while selecting a plan. That way, you can make sure your drugs are covered and hopefully avoid any unforeseen issues.
Finally, it’s unfortunate that most of the reviews and ratings of Part D plans are negative ones. We want positive ones! We know that many Americans are benefiting from the plans. To whomever this applies: please help your peers by reviewing and rating the Part D plans that you like.
Good luck searching for the right plan!
Tagged with: Medicare Drug Plans, Medicare Part D, medicaredrugplans.com
October 15th is just under two weeks ago, and while that date might not mean much to those not enrolled in Medicare, it marks the beginnings of open enrollment for Medicare’s Part D pharmacy benefits. That means that if you are looking for a new Medicare plan, you have until December 7th to do so. Even if you don’t think you need a new plan, you should check out what’s available, for a variety of reasons:
- Your plan may be discontinued, in which case, if you do not act, you might be transferred to a plan that is worse for you. There are 14% fewer plans in 2015 than there were in 2014.
- New plans exist, and they might be better than your current plan.
- Your prescription needs have changed. If you started taking a new medication in 2014 and it wasn’t covered by your current plan, or required you to spend more out-of-pocket than you expected, it might be time to switch to a plan that covers any new meds.
Our sister site, MedicareDrugPlans.com, can help you find a new plan. It compares premiums, deductibles, and even lets you know if drugs are covered during the coverage gap. More importantly, you can read reviews from enrollees who have actually signed up for these plans! Knowing the costs and coverage can only go so far, as these reviews tell us:
Alabama, Tennessee – Cigna-HealthSpring Rx –Reg12
“I have been trying to sign up for this plan but have a very hard time getting answers. Many of the telephone reps answer questions with “I don’t think so or I’m not sure” which is not helpful. They also require you to sign a statement that says “Humana has the right to change the program at any time if they notify the customer.” I have been told that this is just a formality but it makes me nervous.”
New York – First Health Part D Value Plus
“I used this plan in 2013 and it was pretty good…most prescriptions cost me 0. But some prescriptions were not covered and I had to scramble to find the drugs elsewhere. Their cost per month was good, but now it is going up, and I will be switching to a cheaper monthly cost plan.”
Once you read reviews and compare plans on MedicareDrugPlans, head over to the government’s site, www.Medicare.gov, at which you can type in the drugs you take and find out which plans offer the best coverage for you. Using Medicare.gov and ratings from MedicareDrugPlans.com will help you make a fully informed decision. And don’t forget to leave a review on MedicareDrugPlans, so your fellow enrollees can learn from your experiences. Good luck finding the plan that is best for you, and don’t forget to enroll by December 7th!
Tagged with: Medicare Drug Plans, Medicare Part D, medicaredrugplans.com
Last week, we reported on proposed changes to Medicare Part D that could have made it harder for millions of seniors to obtain prescribed medicine. One congressman from Pennslvania, Tim Murphy, went so far to say that suicide rates would increase as a result of the proposed changes, referring to a change that would have allowed insurers to reduce coverage for antipsychotics, immunosuppressants, and antidepressants. Other proposed changes included allowing the government to intervene in contracts between insurers and pharmacies, limiting the number of drug plans available, and also expanding access to community pharmacies.
Outcry from both sides of the aisle, as well as patient and consumer rights advocates, has resulted in the Obama administration reversing course on the changes. “We will engage in further stakeholder input before advancing some or all of the changes in these areas in future years,” wrote Marilyn Tavenner, Administrator of the Centers for Medicare and Medicaid Services.
We are glad specifically that coverage for critical medication will remain strong and that the number of drug plans will not be limited in certain areas. We know that the intention of reducing drug plans was to help make it easier to choose a plan. On the other hand, we support expanding access to community pharmacies and hope for further action on that front.
Fortunately, there are online resources that can help with this. Not all Medicare drug plans are created equal. PharmacyChecker.com runs MedicareDrugPlans.com, which you can use to compare plans and read or write reviews on those plans available in your area.
Tagged with: Marilyn Tavenner, Medicare Part D, medicaredrugplans.com, Tim Murphy