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Medicare Part D - bait and switch
Old 03-21-2016, 01:32 PM   #1
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Medicare Part D - bait and switch

This is a warning to people who have a Medicare Drug plan. As you know, each year you select a new plan. My spouse is narcoleptic and must take a particular drug. There is a generic version that is just fine for him. These drugs are very expensive. When he researched this year's plan during Open Enrollment, Humana said that the charge would be $40/month on the plan that he chose. Now that it is time for him to fill his Rx - they are now going to charge him $206/month.

Also, though a generic, this drug is not the original drug that they quoted. As a matter of fact - they switched this to another version we can't even find drug listed on the Medicare approved list. The original drug they quoted during open enrollment was denied and he was told that he must try this other drug first, at a 3-fold increase.


Prior to this - we had AARP drug plan and there was none of this "bait and switch" that is going on with Humana.

Humana's response was "well, the cost went up".

My husband even has a copy of the actual cost that Humana quoted him at the time when he was shopping for a 2016 Drug plan - Part D. "Too bad, too sad" is the context of Humana's reply on challenge.
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Old 03-21-2016, 01:44 PM   #2
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BTW - I should mention that as of yesterday, he has researched some of the other large companies providing Part D - and none of them have changed their pricing on this drug. By "this drug", I mean the name brand and its generic counterparts.

Apparently - we are one of many consumers. If you are interested - there are many threads here about the same kind of issue. There are additional sites talking about this.

https://www.consumeraffairs.com/insu...source-rx.html

They tell you to "shop" for your drug plan but allow the company to change horses mid-stream. BEWARE. So much for government oversight.

This has not been a pleasant surprise. So ---- "shop every year for a new plan" has new meaning for us.
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Old 03-21-2016, 03:01 PM   #3
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molly312,

I use Humana for my Part D and so far so good, although your post and the attached link have me concerned. I pay an $18/mo premium and take 5 maintenance drugs. Since they are all generic, my cost, so far, is zero (mail order). No deductible and no co-pay. Non-generic drugs have a $360 deductible and the copay varies with the tier.

Could you be a little more specific about your DH's situation? Did Humana change the tier of the drug he's taking? Is it a "specialty" drug? Have you gone to GoodRx.com to see what the uninsured cost would be?

An increase from $40 to $206 is staggering and I'd like to understand more.
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Old 03-21-2016, 03:05 PM   #4
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I believe you can change your Plan D provider at anytime in the year. You will want to confirm, but if so, simply go to the next better option. Certainly a PIA, but beats dealing with Humana--I dropped for some of the same silly behavior and dismal customer service.
Good Riddance!
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Old 03-21-2016, 03:11 PM   #5
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Originally Posted by nwsteve View Post
I believe you can change your Plan D provider at anytime in the year. You will want to confirm, but if so, simply go to the next better option. Certainly a PIA, but beats dealing with Humana--I dropped for some of the same silly behavior and dismal customer service.
Good Riddance!
I don't think that's true. I believe it's one year at a crack.
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Old 03-21-2016, 03:27 PM   #6
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Originally Posted by youbet View Post
I don't think that's true. I believe it's one year at a crack.
Right, only during open enrollment was my understanding as well.

Molly312, have you considered filing a complaint with your state insurance regulator and Attorney General?
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Old 03-21-2016, 03:35 PM   #7
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I don't think that's true. I believe it's one year at a crack.
I stand corrected--during open enrollment Oct 15-Dec7.
I think I made a big leap from a comment that you do not have to tell a provider you are leaving as the new provider will

Second the earlier recommendation to appeal to your state insurance commission especially since you have their original dated quote.
Apologies for any confusion
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Old 03-21-2016, 04:08 PM   #8
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We had the same issue with Humana as they changed DW's inhaler right after closing out open enrollment. The drug went from a few dollars to several hundred. Good thing her doctor could switch her to another lower priced drug. Next year, no more Humana.

Oh, and I don't believe there is any government oversight (drug costs) on Part D plans under Medicare.
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Old 03-21-2016, 04:13 PM   #9
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Well, shaken by molly312's unfortunate experience and also by the experiences related in the url molly123 included, I went to the Humana web site to check on the refills I ordered online Friday. Looks OK. All filled and shipped at no cost as expected. Now, if the USPO can just get 'em here.........

I'm thinking that the root of molly312's problem resides here:

Quote:
Also, though a generic, this drug is not the original drug that they quoted. As a matter of fact - they switched this to another version we can't even find drug listed on the Medicare approved list. The original drug they quoted during open enrollment is not now even available.
I'm really curious as to what happened to the original drug and how the substitute fits in. Is it really a "bait and switch" or has something happened where the drug they quoted durng the enrollment period has been withdrawn from the market and the only replacement available is a higher tier?

In the plan I have (Humana Walmart), the highest coinsurance is 35% (non-preferred brand and assuming you stay in network), so that means the drug in question would be $206 / .35 = $589 a month without insurance. Ouch! OP did mention it was an expensive drug. OP will be in the "doughnut hole" well before the end of the year and that's where the real trouble starts.
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Old 03-21-2016, 04:21 PM   #10
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When do insurers change their drug lists for Part D? Is it at the first of the year, and sign up for the plans before then.

But it looks like the companies issue a "2016 Annual Notice of Changes packet" by enrollment time for the following year.

I guess the Formulary can change at any time during the year, but maybe only for certain reasons? like:
  • The plan no longer covers a drug.
  • A new drug is added.
  • A drug is moved to a different cost-sharing Tier.
  • A Prior Authorization, Step Therapy restriction or Quantity Limit has been added or changed for a drug.
  • A drug is removed from the market.
(this was from Silverscript)

Hmmm - I guess the first one is a wide open door.
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Old 03-21-2016, 04:21 PM   #11
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Coordinate with the prescriber to submit a formal "tier exception" or "formulary exception" request. The Customer Service Reps do not have authority to help. This request is different from the normal authorization process.

Exception request: http://apps.humana.com/marketing/doc...p?file=1828827

Quote:
Question: Once I join a Medicare Part D plan and I am locked-in for the year, can my Medicare prescription drug plan drop medications from its drug list during the year?

Answer: Your Medicare Part D prescription drug plan's formulary or drug lists can change throughout your coverage year - with approval from CMS....You can ask your Medicare Part D plan for a formulary exception or coverage determination whereby you would continue to receive coverage for your existing medication.

If your request for a formulary exception is denied, you may wish to consider filing an appeal to get your drugs covered for the remainder of the plan year.
Reference: http://www.q1medicare.com/q1group/Me...ategory_id=127
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Old 03-21-2016, 04:22 PM   #12
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Your pharmacist likely has a good idea of which insurers do a reasonable job for their rx customers, and which do not. Before selecting a plan it might be worth talking with the pharmacist.
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Old 03-21-2016, 04:24 PM   #13
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No the original drug has not been withdrawn. Other Medicare D companies are listing it and have maintained the original quoted price. This very same drug was part of Humana's quote for 2016. They dropped the original drug and replaced it with a "new" generic/brand? that several other companies don't even include in their formulary . The original drug that my husband has ALWAYS taken for 10 or more years - is the one that was prescribed and submitted to Humana. Humana told us that this new drug is the only choice they would provide, along with a HUGE increase in price. There are not a lot of drug choices for narcolepsy.

-His original drug was NOT removed from the market.

-He always has "prior authorization" from his doctor.

-The 2016 formulary that Humana provided during the official "sign up" period, included the original drug at a much lower monthly price than $206.

LookS like they made the change middle of January right after the close of "open enrollment". That is what I call "BAIT AND SWITCH"!
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Old 03-21-2016, 07:21 PM   #14
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Quote:
Originally Posted by molly312 View Post
............
Looks like they made the change middle of January right after the close of "open enrollment". That is what I call "BAIT AND SWITCH"!
My suggestion is to elevate your complaint each time you call to complain. I nearly always get my way eventually, especially if I'm sure that I'm in the right. The low level customer service reps don't have much authority and frequently don't even actually understand the complaint - their job is to wave off the timid.
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Old 03-21-2016, 07:42 PM   #15
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Humana is on top of my $hit list.

WIll dump come open enrollment. What makes it worse is that I got Humana via USAA.

Three years ago I got a shot in the doctor's office. For which the doctor billed me, and I paid him promptly. The doc should not have to wait until Humana paid me.

Submitted the doctor's bill to Humana for the shot along with copy of my cancelled check showing payment to the doc. ONE YEAR later Humana sent me a Notice of approval and in that the statement that in a few weeks I'll get a check.

After many go arounds two years passed and no money.

Asked USAA as they recommended Humana and I signed up thrugh USAA to assist in collecting. After several email go arounds with USAA inHuman said they will not pay.

Therefore, as I explained to USAA, I will never accept any recommendations from USAA for anything not directly serviced by them. And will dump Humana at the next available opportunity which is: open enrollment.

My guess is that the reason USAA recommends inHumane is: They offer the greatest kickback to USAA. WHich of course inHumane can easily do since they have a thousand ways of shafting the conssumer.
THus by proxy USAA is also on my $hit list, but nowhere near the top, YET.

If the above seems like a rant, it is.
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Old 03-22-2016, 06:15 PM   #16
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Another Humana story that will make you feel warm and fuzzy about them...........I have pt D w/ them and autopay each mo. via checking account......something like $15-$20/mo. One day there was a withdrawal
of some hundreds of $$$ which the bank said was from Humana. Called them
and (don't remember all the details for sure) they were totally not interested
in the details......didn't want to research it and said to send in any documentation that I have and they would deal w/ it in their own sweet time.
A good learning experience for me.....I learned that the bank has the power to cancel that transaction so I requested it on paper and they did. Never heard anything from Humana explaining or apologizing for their mistake.

Later my blood pressure medication came out w/ a generic version. In my simple mind, generic is associated w/ lower cost so I was quite surprised that the generic at that point in time cost more. Maybe they were trying to trap the naive like me. Fortunately I did not fall into their trap but it sensitized me to clever sales techniques like that and the Amazon free 2-day shipping schemes.
Free education.
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Old 03-22-2016, 08:03 PM   #17
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Later my blood pressure medication came out w/ a generic version. In my simple mind, generic is associated w/ lower cost so I was quite surprised that the generic at that point in time cost more.
While it usually is the case, generics are not always cheaper, at least initially. The name brand companies will sometimes lower their price when a generic hits the market, just to keep market share.
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Old 03-23-2016, 06:50 AM   #18
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By law I believe they can change the drug formulary any time they want, but must give 60 days notice.
You should have gotten a formulary change letter.
If you have a legitimate gripe, call medicare, and they can start a case,the last thing
Humana would want is to be delisted, from Part D,open enrollment.
My United America plan was delisted this year for some sort of none compliance, but I could stay with them if I chose.
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Old 03-23-2016, 08:59 AM   #19
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While it usually is the case, generics are not always cheaper, at least initially. The name brand companies will sometimes lower their price when a generic hits the market, just to keep market share.

In my case, the brand was unchanged . " They" just priced the generic higher....makes no sense to me why the generic company would do that since
Humana wouldn't carry them so I assumed Humana priced it that way.
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Old 03-23-2016, 09:37 AM   #20
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Clearly there is something going on at Humana. Apparently they don't do fixed rate contracts. They just quote any price during open enrollment and then stick it to you as soon as enrollment period closes. Checking with the other PartD companies and their plans --- they have NOT increased the price for the original formulary my husband uses and in point of fact ---- they have lowered the price. Matter of fact - we can't find any of them using this new formulary.


We are obviously voting with our feet during open enrollment but unless the ethics of this company take a dramatic change I would advise anybody who is on Medicare to stay away from Humana. Fortunately - we do NOT have them for our Medigap.

We can afford the increased cost - don't enjoy it and didn't plan on it - however, somebody who is on a really tight budget would be severely hurt by these pricing practices.

We have contacted Medicare at both the state and federal level. Next is our Senator who has a top seat on the Aging committee that is currently discussing and exploring these issues.
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