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Old 10-17-2019, 07:39 PM   #21
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Originally Posted by Telly View Post
All in one place for all plans, no.

I am soon to be ex-Aetna, and have been looking at the Wellcare plans. They want to stick me in the Wellcare Medicare Rx Select, at a 30% increase in cost. No. So I am looking at their Wellness Rx plan, which is second from cheapest in my area (Humana Walmart is cheapest). If you poke around long enough on Wellcare.com, you can find the Formulary, and you can see drug prices depending which of their plans you choose. And looking at the prices you can see which pharmacies are preferred. The only real info that you need to enter are state and zip, and throw some pharmacy chains at it.

Last night, the Medicare Plan Finder would no longer give any drug price info for their Wellness Rx Plan. Same thing this AM. Great... I wondered if they were pulling the plan, but it works fine on Wellcare's website. I tried a far-away zipcode here in TX on Medicare.gov, same thing. Tried another STATE, and costs came back. So I don't know, is that a Medicare.gov problem, or Wellcare not feeding some info to Medicare.gov? Dunno. But it was working before. The Wellcare Medicare Rx Select plan continues to work on Medicare.gov.
We have three low-cost WellCare plans, the two you list plus an intermediate plan, WellCare Value Script. The cheapest plan has the local Safeway pharmacy as preferred, CVS is not. The middle plan has CVS as a preferred pharmacy, Safeway is not. WellCare Medicare RX Select has both as preferred pharmacies. Costs are $13.70, $16.80, and $23.80, respectively. For one Tier 1 drug, the cheapest way to go is the Wellness Rx plan, using the Safeway pharmacy, at least according to the Via Benefits site.

However, for 2019, the Tier 1 drug on the Aetna plan was supposed to be free. It was not. It was $2.00 at CVS, the preferred pharmacy. I don't have a lot of faith in what these sites tell me about prescription cost as a result.

Express Scripts and Silver Script are more expensive at $28.50 and $30.50. The drug is not "free" with these plans.

My initial take is to pick one of the three cheap WellCare plans, based on which pharmacy I am likely to use. However, there may be an error in not including both pharmacies on one or both of the cheaper plans. At least one way of searching turns them both up on all three plans.

I suspect the software will be revised over the next couple of weeks as errors and inconsistencies are discovered and resolved. I will probably wait a few weeks before tackling this decision.


ETA: Medicare,gov is a lot easier to use and its' list of preferred pharmacies are the same as my initial list. The costs are the same so no upcharge for using Via Benefits. The print is bigger and easier to read as well!
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Old 10-18-2019, 05:48 AM   #22
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Update on our clawback from Walgreens/Highmark regarding Shingrix. After Monday's call to Highmark, our $1800/month insurer, the customer service rep assured DW that it was a covered expense, as a medical procedure. DW went to our Walgreens with receipts and names and phone numbers of Highmark's customer rep yesterday, and presented her case. Walgreen's tried for 30 minutes to rebill Highmark but all attempts were futile. Walgreens then called Highmark rep for assistance; and the that's when the SHTF! The Highmark rep told the Walgreens pharmacy department that as of 10/15/19, the Shingrix vaccine was no longer a covered expense.

DW stormed out and called Highmark as soon as she got home, and was on the phone with the rep's supervisor for over an hour, to no avail. The Highmark supervisor then gave DW a list of providers that did give the Shingrix vaccine in our area, and we explained that every provider on that list has no vaccine available on site and their waiting lists are over 200 patients long, were longer accepting names, for over 18 months. We are at a standstill but this fight is not over. DW is on this.

However, I have been vaccinated with the first dose, and it has cost me $150+ to get it.
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Old 10-18-2019, 05:58 AM   #23
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Update on our clawback from Walgreens/Highmark regarding Shingrix. After Monday's call to Highmark, our $1800/month insurer, the customer service rep assured DW that it was a covered expense, as a medical procedure. DW went to our Walgreens with receipts and names and phone numbers of Highmark's customer rep yesterday, and presented her case. Walgreen's tried for 30 minutes to rebill Highmark but all attempts were futile. Walgreens then called Highmark rep for assistance; and the that's when the SHTF! The Highmark rep told the Walgreens pharmacy department that as of 10/15/19, the Shingrix vaccine was no longer a covered expense.

DW stormed out and called Highmark as soon as she got home, and was on the phone with the rep's supervisor for over an hour, to no avail. The Highmark supervisor then gave DW a list of providers that did give the Shingrix vaccine in our area, and we explained that every provider on that list has no vaccine available on site and their waiting lists are over 200 patients long, were longer accepting names, for over 18 months. We are at a standstill but this fight is not over. DW is on this.

However, I have been vaccinated with the first dose, and it has cost me $150+ to get it.
Now you have me concerned, as Highmark is also our insurance company. DW will likely get the first dose in the coming weeks, and will try filing a paper claim.

In the long run, if we can avoid shingles for about $300 apiece out of pocket, it is still a good deal.
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Old 10-21-2019, 05:38 PM   #24
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2 silly questions. Is there still a shortage most places? Why don't you get these at the doctor if its a "medical procedure"?

Sorry if this was obvious, but I am not on Medicare.
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Old 10-21-2019, 05:54 PM   #25
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2 silly questions. Is there still a shortage most places? Why don't you get these at the doctor if its a "medical procedure"?
Yes, there is still a shortage in most places. Not all the time, but many places around me won't even take a waiting list (though some do).

JMHO, I think the medical procedure issue is one of availability and and cost.

Pharmacies seem to be the low cost provider (like flu vaccines). I would guess the majority of folks getting the Shingrix vaccine are of medicare age, and they code it as a vaccine. My HI provider has said they will cover if we pre-pay and submit. But they will only cover to the "allowed amount", what ever that is.

Bottom line: If we need to pay 200-300 each to avoid shingles. I consider it a no brainer.

SIL had it about a year ago. still a lot of scarring on the face, and she was very lucky it did not go into the eyes.
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Old 10-21-2019, 06:17 PM   #26
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Shingrix is is not a "medical procedure" it is a vaccine and, at least under Medicare it comes under the Part D pharmacy coverage. Not sure about whether there is still a shortage since we have now had both shots. I had a terrible case of Shingles over 15 years ago and I still suffer from post herpetic pain. When the new Shingles shot came out I made it a priority to get it, spent many hours tracking the shots down, finally had to drive several hours away to get the second shot. I would say whatever you have to do GET SHINGRIX. I would give anything not to have had Shingles.
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Old 10-21-2019, 06:58 PM   #27
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Shingrix is is not a "medical procedure" it is a vaccine and, at least under Medicare it comes under the Part D pharmacy coverage. Not sure about whether there is still a shortage since we have now had both shots. I had a terrible case of Shingles over 15 years ago and I still suffer from post herpetic pain. When the new Shingles shot came out I made it a priority to get it, spent many hours tracking the shots down, finally had to drive several hours away to get the second shot. I would say whatever you have to do GET SHINGRIX. I would give anything not to have had Shingles.
Bold by me.

Many (most?) Pre-medicare plans code it as a medical procedure, and cover it that way. That is the reason for some of the coverage confusion.
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Old 10-21-2019, 07:02 PM   #28
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Hmm, well I get flu shots at doc office, wouldn't it be same? I guess I thought all preventive stuff was covered. I have an appointment coming up, will ask if they have the vax. The fact so many of you are concerned about this tells me its important even though I don't know anyone who has had shingles.


** It just occurred to me my insurance is all one "plan" for drugs and doctors so that must be the difference? So once medicare age that all changes? I mean I knew you all had a drug plan but *preventive* changes too?
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Old 11-18-2019, 09:28 PM   #29
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Originally Posted by Winemaker View Post
Update on our clawback from Walgreens/Highmark regarding Shingrix. After Monday's call to Highmark, our $1800/month insurer, the customer service rep assured DW that it was a covered expense, as a medical procedure. DW went to our Walgreens with receipts and names and phone numbers of Highmark's customer rep yesterday, and presented her case. Walgreen's tried for 30 minutes to rebill Highmark but all attempts were futile. Walgreens then called Highmark rep for assistance; and the that's when the SHTF! The Highmark rep told the Walgreens pharmacy department that as of 10/15/19, the Shingrix vaccine was no longer a covered expense.

DW stormed out and called Highmark as soon as she got home, and was on the phone with the rep's supervisor for over an hour, to no avail. The Highmark supervisor then gave DW a list of providers that did give the Shingrix vaccine in our area, and we explained that every provider on that list has no vaccine available on site and their waiting lists are over 200 patients long, were longer accepting names, for over 18 months. We are at a standstill but this fight is not over. DW is on this.

However, I have been vaccinated with the first dose, and it has cost me $150+ to get it.
Update on above issue with Highmark and Shingrix vaccine.


I received a $153 check today from Highmark; after DW wrote 1 letter and provided receipts. I have been made whole , however DW was not compensated for her hour of paperwork.
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