2020 Plan Finder Part D, ShingRx, and frequency

[Telly]

When using the Medicare 2020 Part D drug plan finder, and entering drugs, I have an issue.
I do not take any prescription meds, but did want to see what the plans looked like if I put in the ShingRx vaccine, which is covered under Part D.

I expected to be able to enter ShingRx 1 time every 6 months, or twice annually, either would have sufficed for the 2-shot sequence of ShingRx.

But no. The plan finder drug input area for each drug "taken", makes you choose quantity and frequency. And the frequency choices are 1 month, 2 months, or 3 months. No six month or annually.

I could choose the longest "frequency" they have available (every 3 months), and one item in that period, but that creates a 4 times in one year setup, which gives much higher prices, of course. And muddies the water greatly, with me then trying to divine the actual insurance to me price per-shot, to try to figure out what it looks like with the info they give me. And I don't have great confidence in what I come up with!

I'm pretty sure that I looked at this in spring of this year, on the 2019 plan finder, and could do it, that a longer period was available that would work. But not the 2020 finder. I input my comments about this, FWIW, a few days ago on their feedback mechanism.

Any thoughts?

 

[Chuckanut]

From what I can tell the Tier levels are what drives the overall cost the most. My drugs are all Tier 1 so it does not affect me much. But, one acquaintance has found that his expensive Tier 4 drug is a Tier 2 drug with another plan. The monthly fee adds about $220 a year, but the cost of the drug is about $600 less.

 

[CardsFan]

Based on this thread, I did a little "googling" about the topic, since DW and I both will go on Medicare next year. From what I found on the few sites I visited, while most Part D plans "cover" the Shingrx vaccine, you will still need to satisfy your deductible first. Even then, depending on the tier level for your plan, you may still pay 10% to 50% of the cost.

Based on this, we both plan to get the vaccine before going on Medicare. Current insurance will cover at no cost.

 

[Sarah S]

I entered the shingrix as you did for 4 doses in a year. Even halving those I got ridiculous numbers and if I actually needed shingrix and the numbers were real I would pay cash instead. I looked up my visits for shingrix from last year. My pcp billed my aca plan 375 each and got less. I am not sure you should pick your plan including shingrix !

 

[Z3Dreamer]

The new plan finder is still being worked on. And today, the Medicare servers were overwhelmed with enrollments. Drugs that are once a year and things like Shingrix (twice) have not been programmed in, yet. I was advised to not make any decisions this week as even drug prices are not quite in the new program yet.

 

[REWahoo]

The new plan finder is still being worked on. And today, the Medicare servers were overwhelmed with enrollments. Drugs that are once a year and things like Shingrix (twice) have not been programmed in, yet. I was advised to not make any decisions this week as even drug prices are not quite in the new program yet.

+1

I saw some squirrelly results when I used it this AM.

 

[NoMoreJob]

Our agent stopped advising on Part D this year and referred all his clients to a specialist that handles only Part D for that. I believe the specialist has some proprietary software to handle Part D selection. Previously our agent used the Medicare Plan Finder functionality to help guide his clients but says he can no longer trust it to locate the best plan. Apparently Medicare has promised to add this functionality back but can't get it done in time for this year's sign-up.

 

[Winemaker]

My non Medicare insurance classifies the Shingrix vaccine as a "medical procedure" and bills as such. I have been trying to find someone who had the serum for over 18 months, since I turned 60. I got my shot last Thursday and I can get the 2nd shot in 2 months.

 

[Chuckanut]

+1

I saw some squirrelly results when I used it this AM.

I did also. Cost estimates did not make sense to me, even allowing for one drug that was Tier 2 in one plan and Tier 4 in another. I think I will delay my decision until two weeks before the deadline.

 

[Z3Dreamer]

My sources told me that drug companies were not required to get in final drug prices until 10/15. Medicare was going to update their database overnight, so you will not have good numbers until mid-day 10/16 - today. Maybe.

If you access/setup an account on Medicare.gov, the plan finder will find you the cheapest overall plan for your drugs. I have seen it in action and it does a good job. It is just a little quirky, at the current time. And it requires some patience to read through the results. Total drug prices are in the lower right side of the box for each plan. Premiums are in the upper left of each box.

 

[Telly]

I entered the shingrix as you did for 4 doses in a year. Even halving those I got ridiculous numbers and if I actually needed shingrix and the numbers were real I would pay cash instead. I looked up my visits for shingrix from last year. My pcp billed my aca plan 375 each and got less. I am not sure you should pick your plan including shingrix !

I played with it some more this AM. Until/If they fix it to have an annual frequency rate, it's going to spew out garbage.

Nonetheless, I picked through the garbage... I found that in the grayed-out area (who uses a grayed-out area for input) that the default setting was Standard Retail Pharmacy. I didn't realize that that line was selectable! So I set it to Preferred Pharmacy.
Also diddled with the entry of ShingRx with their Drug and Package Type settings. I set to ShingRx 50mcg/0.5ml suspension reconstituted, and Package Type to Vial of 1 suspension reconstituted.
So now I got the 4 times a year drug prices in the $500s range, rather than the $1300 - 1500 range of yesterday. So those were my mistakes, created by their horrible interface.

Still 4 times a year, instead of 2, but I got numbers for the plan I most likely will go with, then picked through that garbage. It said $564.27/yr in drug costs.
Said the Preferred Pharmacy's (CVS) costs were:
Retail cost $148.09
Cost before Deductible $148.09
Cost AFTER deductible $120 (what? more on that in a bit!)
Then showed cost per every 3 months (the longest selection) as $148.09 for three of the periods, and $120 for the fourth period, which all adds up to the $564.27/yr

I could not figure out why AFTER the $435 deductible was met, it was charging $120, when the copay for this plan for Tier 3 Preferred Drug is $40! I have the complete coverage tables printed out from the provider's website, and looking at it, realized that instead of the $40 copay I just mentioned, they used the 90-day copay of $120! So all the numbers now worked out... at least I could see what it did.

My course of action - Whether Medicare fixes their program or not, I saw that the provider's negotiated cost for a ShingRx dose was $148 before deductible. So the 2 shots in a year isn't going to meet the deductible, and furthermore, selecting a No or very low deductible plan for a year to try to cover ShingRx cost + premium cost, won't be the way to go. Someone early this year suggested to look at that idea, and see how/if it works out with a lower total. I think a big change since then, at least in my area, is the almost universal adoption of the full deductible. In 2018 when I got started, there were around a third of the plans having a greatly reduced or zero deductible. Not anymore, one with zero, two reduced. And the premiums are so $$$. So I think I put that idea to bed here, and will carry on with the low-premium placeholder plan idea. YMMV.

 

[CardsFan]

My non Medicare insurance classifies the Shingrix vaccine as a "medical procedure" and bills as such. I have been trying to find someone who had the serum for over 18 months, since I turned 60. I got my shot last Thursday and I can get the 2nd shot in 2 months.

My pre-Medicare insurance also classifies it as a medical procedure. My problem has been finding a Pharmacy that will bill that way. Everyone I have talked to so far does not.

Did you have to pay up front, and then submit a claim? Or were you able to find a chain that would bill as medical, not prescription?

 

[Animorph]

I didn't have much luck with Shingrix when checking Part D plans. But GoodRx seemed to have pretty good info on cash cost and cost with a PDP. They allow you to select your Part D plan as part of the process.

 

[harllee]

Last year when I was searching for Part D providers and also knew I wanted to get the Shingrix shots I chose plans with zero deductibles and then called them and asked what the Shingrix shot would cost under their plan. I chose Silverscript and it worked well for the Shingrix shot. Silverscript paid half of the cost of each shot (around $85) and I paid the rest. I could never get the Medicare website to work for Shingrix so I just called a few insurance companies to get the Shingrix cost.

 

[Winemaker]

My pre-Medicare insurance also classifies it as a medical procedure. My problem has been finding a Pharmacy that will bill that way. Everyone I have talked to so far does not.

Did you have to pay up front, and then submit a claim? Or were you able to find a chain that would bill as medical, not prescription?

I had been waiting for local grocer pharmacy for serum for 18 months, also checked with PCP; they didn't have it. I went to Walgreens, and they had serum. After they checked on computer, they said my insurance didn't pay. I got the shot, paid $180, but then the clerk said they used a $30 coupon to bring it to $150. DW called insurance, and they said it was a covered expense; and go back and have them rebill/submit under the medical procedure code. DW is going tomorrow to argue/discuss/ persuade, as we have been busy with wine/grape season. I'll get back to you once everything is settled.

 

[CardsFan]

I had been waiting for local grocer pharmacy for serum for 18 months, also checked with PCP; they didn't have it. I went to Walgreens, and they had serum. After they checked on computer, they said my insurance didn't pay. I got the shot, paid $180, but then the clerk said they used a $30 coupon to bring it to $150. DW called insurance, and they said it was a covered expense; and go back and have them rebill/submit under the medical procedure code. DW is going tomorrow to argue/discuss/ persuade, as we have been busy with wine/grape season. I'll get back to you once everything is settled.

Sounds like the same thing we are going through. BCBS says if they can't/won't bill as a medical procedure, then I can pay and submit myself, and BCBS will pay me the "customary" amount, which could be less than what I pay.

Let us know if you have any luck with Walgreen's billing as medical.

 

[frank]

went on the medicare.gov yesterday to check on the new plans. about 8 oclock I signed in and went throught the steps. the prices for my drugs were outrageous. I got preoccupied with something for a while and when I went back the prices had changed dramatically. I think maybe wait a week or two before doing anything and checking to see if they got all the bugs out of the system.

 

[Another Reader]

Using Via Benefits, the list of preferred pharmacies for each plan is no longer available. Apparently you have to put in your drugs and your pharmacy choice, and a list of plans by total cost comes back. To see if another pharmacy is on the preferred list, you have to change the pharmacy and rerun the search program.

In my case, the two cheapest plans are Wellcare, who took over Aetna's Part D business. Also known as Well-fare, because they focus on the Medicaid and Medicare Advantage businesses. The cheapest plan has Safeway pharmacy on their preferred list but not CVS. The second cheapest has CVS but not Safeway. I'm skipping Humana Walmart, which is close in total cost, because I won't give Humana money after what I read here and I don't do Walmart.

Sure would be nice to look at the preferred pharmacy list for all plans and the formularies. Any ideas on where to get this information?

 

[Telly]

Sure would be nice to look at the preferred pharmacy list for all plans and the formularies. Any ideas on where to get this information?

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.

 

[aja8888]

Part D for DW (Ugh!)

Just ran the trials on Medicare.gov Part D site for DW's 12 drugs, two of which are Tier III and no generics. Came up with an annual OOP of ~$15,000 not counting plan premiums. Damn.........

The 2019 plan she has appears to be closing out at ~$5,000 OOP not including premiums. What the heck??

The big increase is with Breo Ellipta (Glaxo's drug) which she needs to treat her COPD. Some plans show a monthly retail of $20,000 for the drug with donut hole charge of $5,600 and monthly in the $100's.

Medicare is so much fun. Add in about $4,000 for her Medicare and Supplemental Full F Plan, and we are in ACA TERRITORY!!

 

[Another Reader]

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!

 

[Winemaker]

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.

 

[CardsFan]

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.

 

[badatmath]

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.

 

[CardsFan]

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.