Complexity of Purchasing Prescription Medications

[travelover]

........... the cash price of $70 .......... This charge submitted to insurance is $234. The insurance company pays them $177, leaving me to pay $57.............

Did I mention that small time crooks wear hoodies and big time crooks wear suits and lab coats?

 

[REWahoo]

I should have been more specific; in your case I can see the benefit. However, we take no expensive medications so for us it is almost cheaper to buy them without insurance.

Insurance is always a waste of money - until you need it.

 

[harllee]

I should have been more specific, I updated my post; in your case I can see the benefit. However, we take no expensive medications so for us it is almost cheaper to buy them without insurance.

But how do know you will not ever need expensive medications? What if you develop cancer or rheumatoid arthritis or something similar? If you drop your Part D now you can only add it at the end of the year and you will pay a large penalty when you start it back.

 

[Z3Dreamer]

But how do know you will not ever need expensive medications? What if you develop cancer or rheumatoid arthritis or something similar? If you drop your Part D now you can only add it at the end of the year and you will pay a large penalty when you start it back.

I think the plan is to have an inexpensive Part D, then, if you need it, go whole hog during open enrollment. The case of not having Part D, at all, would not be recommended.

 

[harllee]

I think the plan is to have an inexpensive Part D, then, if you need it, go whole hog during open enrollment. The case of not having Part D, at all, would not be recommended.

Yes, I use no prescription drugs now and I have the least expensive Part D "just in case".

 

[gauss]

If you are ever prescribed a very expensive medication (like a cancer medication or Humira) having Part D will save you thousands, especially once the new rules limiting patient cost to $2000 per year. Even now having Part D saves my husband over $10,000 per year on his Humira.

My question on this is does the upcoming $2,000 cap on Rx drug copays only count towards drugs that are covered by your particular Part D plan or does it cover all FDA/CDC approved drugs.

This is the question I have had since seeing the approval of the Inflation Bill, but I have not seen it addressed anywhere yet.

I am still over 5 years out from Medicare eligibility so pardon my question if this is obvious to folks currently enrolled.

-gauss

 

[teej1985]

My question on this is does the upcoming $2,000 cap on Rx drug copays only count towards drugs that are covered by your particular Part D plan or does it cover all FDA/CDC approved drugs.

This is the question I have had since seeing the approval of the Inflation Bill, but I have not seen it addressed anywhere yet.

I am still over 5 years out from Medicare eligibility so pardon my question if this is obvious to folks currently enrolled.

-gauss

It absolutely would only cover what you run through your insurance.

 

[harllee]

My question on this is does the upcoming $2,000 cap on Rx drug copays only count towards drugs that are covered by your particular Part D plan or does it cover all FDA/CDC approved drugs.

This is the question I have had since seeing the approval of the Inflation Bill, but I have not seen it addressed anywhere yet.

I am still over 5 years out from Medicare eligibility so pardon my question if this is obvious to folks currently enrolled.

-gauss

I think it only covers drugs that are covered by your Part D insurance. It will make picking the right Part D plan even more important

 

[target2019]

My question on this is does the upcoming $2,000 cap on Rx drug copays only count towards drugs that are covered by your particular Part D plan or does it cover all FDA/CDC approved drugs.

This is the question I have had since seeing the approval of the Inflation Bill, but I have not seen it addressed anywhere yet.

I am still over 5 years out from Medicare eligibility so pardon my question if this is obvious to folks currently enrolled.

-gauss

In medical insurance lingo, the question is, "Is my drug on the plan's formulary."

I think I may submit that question to my legislator. I will also ask, "Are there safeguards to prevent insurance companies from dropping drugs from their formulary?"

Or maybe I'll ask AARP. https://www.aarp.org/politics-society/advocacy/info-2022/medicare-part-d-changes.html

 

[sengsational]

That's the end of the $7/mo part D plan, I suspect.

 

[frank]

That's the end of the $7/mo part D plan, I suspect.

wellcare just sent my renewal letter and said the premium for 2023 would be 7. and change.

 

[gauss]

That's the end of the $7/mo part D plan, I suspect.

Not necessarily.

It depends on who (ie which entity) will be responsible for the coverage in excess of $2,000.

Someone could dig into the new law to determine this now, I would think.

Today the drug manufacturers along with Medicare itself pay the lions share beyond the initial coverage window. The light blue is the Part D insurance plan's responsibility under the current plan according to:

See figure 6 at
https://www.kff.org/medicare/fact-s...he-medicare-part-d-prescription-drug-benefit/