Our office takes your plan recommendations very seriously. The process isn't as simple as looking for the plan with the cheapest monthly premium. If it were, boy would our jobs be easy! It is also important to remember that what might be an excellent plan for your spouse or friend might be a terrible choice for you. Our bottom line is always your bottom line- what is going to save you the most money overall? What plan is going to give you the best prescription coverage based on your needs?
We first start with your prescription list. We will plug this into our handy-dandy quoting software, along with the dosage, the quantity, the fill rate and your preferred pharmacy. It is very important that you give us the most accurate information you have, and that we in turn input it exactly as you give it to us. This is part of the reason why it takes us a little bit to prepare for your appointment or to make a plan recommendation during the Medicare Annual Enrollment Period. Our office takes pride in providing the best information we can based on the information we have.
Once we have run your quotes, we will be looking at the pharmacy you prefer to use and checking out your total estimated yearly cost. Estimated is bolded and italicized here because that is the best we can provide you-an estimate-based on the information we have from the carriers and you at that moment in time. Using an insurance agent should assure you that you are getting the best estimate available.
When comparing the yearly rates for the available plans, we take a look of at a multitude of things.
How you are currently filling your prescriptions, is this the most cost-efficient method for you?
Would it save you money to switch to a generic?
Would it be less expensive to fill every 30 days at a different pharmacy?
Better to fill every 90 days at a mail order pharmacy?
A mix of the both?
We use every bit of information at our disposal to help us narrow down your choices to provide you with the best coverage we can.
Our office gets a lot of phone calls from client's concerned because a drug price has changed, or it is no longer covered. The price is a lot higher than what we told them it would be. A new drug has been added that their plan does not cover. Unfortunately, that does happen. Your out-of-pocket costs for your prescription drugs can very possibly be different than what we initially discussed.
There are so many reasons this can happen: the carrier has changed the drug cost, the quantity and dosage of the rx is different, the rx itself was replaced by another drug-- and the biggest reason of all is this.
When we make your plan suggestion it is based on that moment in time. It is based on the best available information we have been provided by you and the carrier, and most importantly- it is based on you filling all of your prescriptions on the same day at the same place. If you do not fill all of your prescriptions on the same day, it is very likely you will see some price variance.
You might be wondering why this is. There are different factors that can come into play, but one of the most common we see is that you are filling an expensive prescription and your deductible has not been met yet. Let's look at an example*.
Your plan deductible is $505 for 2023
On your plan summary review with us, your prescription for Carbaglu showed your estimated cost as $200, Eliquis should be $200 and Enbrel is $305.00. You have no other prescription drugs you are taking.
You go into the pharmacy to pick up your first fill of your Eliquis, and you do not fill your Carbaglu or Enbrel because you don't need either of them for awhile.
It is very likely that your Eliqus would cost you the full deductible amount, plus a copay- depending on what the retail cost of the drug is.
Later, when you fill your Cabaglu and Enbrel, your deductible will most likely have been met with your first fill of Eliquis, and you will just have a copay going forward.
I hope this helps to make the prescription cost side of things a little bit easier to understand. If the pharmacy asks you to pay an amount that seems awfully high to you, ask them to tell you why it is expensive. Did your insurance deny the prescription? Is it going to your deductible? Is it a Tier 3 or Tier 4? Make note of any of the information they can provide you and then take a look at your plan summary and formulary book when you get home. If it still is unclear, you can call the member services number on the back of your card, or you can give our office a call and we will do our best to help you figure it out.
Thank you for reading!
* These numbers are purely estimates used to illustrate the example and not based on any real numbers- with the exception of the $505 Part D deductible.