Get the cheapest Part D plan and use Good RX most of the time?

[explanade]

Prescription drug coverage makes no sense.

What is the advantage in paying higher prices for prescriptions just to have them count against the deductible?

After $400 deductible will these plans cover 100%?

Or will Part D really come into play if you need those really expensive drugs, all the gene therapy stuff?

I doubt these plans would cover drugs which go into 6 or 7 figures.

[Montecfo]

It is just math. If your drug cost is a less than the deductible, the drug coverage will appear to make less sense. But it is insuring against price rise AND a future new need for drugs ( due to medical advances or new illness).

GoodRx is great for helping us shop around, but drugs that cost say hundreds a month are still going to feel expensive even at the best retail price.

[ShokWaveRider]

I found that the Shingles Vaccine was $40 more if I used my Insurance rather than buy it directly off the Pharmacy with NO Coupons. The Part D company sets their own prices that are above or below the retail. If I did not pay the Insurance Price it would NOT be used to reduce my deductible. It is a real Con in my books. Another way the Gubment panders to insurance companies, giving them free money at our expense. Deductible are set by the Gubment BUT insurance can pick and choose what to deduct from them.

[candrew]

Quote:

Originally Posted by ShokWaveRider I found that the Shingles Vaccine was $40 more if I used my Insurance rather than buy it directly off the Pharmacy with NO Coupons.

Isn't the Shingles Vaccine covered at no cost as a preventive care benefit for adults age +50 even if you haven't met the yearly deductible? DW & I received our vaccinations (Shingrx) at no cost - "in network", of course.

[ShokWaveRider]

Quote:

Originally Posted by candrew Isn't the Shingles Vaccine covered at no cost as a preventive care benefit for adults age +50 even if you haven't met the yearly deductible? DW & I received our vaccinations (Shingrx) at no cost - "in network", of course.

Not on our Part G. Maybe for Medicare Advantage.

[candrew]

Quote:

Originally Posted by ShokWaveRider Not on our Part G. Maybe for Medicare Advantage.

Oh man, I was thinking about our ACA plans!

[FIRE'd@51]

The Humana/Walmart Value RX plan plan is only $13.20 per month. Tier 1 and Tier 2 generics are not subject to the $435 deductible, so they are covered immediately at a small copay. And, more importantly, you have the insurance in place should you need to take a more expensive drug.

[Bestwifeever]

Quote:

Originally Posted by candrew Isn't the Shingles Vaccine covered at no cost as a preventive care benefit for adults age +50 even if you haven't met the yearly deductible? DW & I received our vaccinations (Shingrx) at no cost - "in network", of course.

Our Part D insurer does not cover the Shingrix vaccine but it does cover another one (Zostavax, I think). DH got revaccinated with Shingrix out of pocket (with a GoodRx coupon that took off maybe $40) when his doc recommended it; I'm okay with the Zostavax shot I got a few years ago.

[Chuckanut]

Quote:

Originally Posted by ShokWaveRider Not on our Part G. Maybe for Medicare Advantage.

+1 My first shot was expensive since I had not met my deductible. My 2nd was about 70% cheaper since I had used up most of my deductible.

[ziggy29]

Quote:

Originally Posted by candrew Isn't the Shingles Vaccine covered at no cost as a preventive care benefit for adults age +50 even if you haven't met the yearly deductible? DW & I received our vaccinations (Shingrx) at no cost - "in network", of course.

I could be wrong but while the Affordable Care Act requires coverage for certain preventative visits and vaccinations, I *think* that only applies to plans that are creditable and compliant with the ACA. Since that applies to plans available through age 64, it may not apply to Medicare Part D plans. Those must only cover what is required by Medicare, and the list is different than it is for an ACA Marketplace plan for those under 65.

Even then, I don't think ACA compliant plans such as those on the Marketplace specify which specific vaccines are covered. (Some still may not be in with the "Shingrix at 50" thing, but still with the older "Zostavax at 60".)

[audreyh1]

I’m pretty sure our ACA plan did not cover the shot initially even though we were old enough. Fortunately by the time we were ready to get it, it was covered. We wanted to go ahead and get it before Medicare for DH since we weren’t sure of the coverage.

[audreyh1]

Quote:

Originally Posted by ziggy29 I could be wrong but while the Affordable Care Act requires coverage for certain preventative visits and vaccinations, I *think* that only applies to plans that are creditable and compliant with the ACA. Since that applies to plans available through age 64, it may not apply to Medicare Part D plans. Those must only cover what is required by Medicare, and the list is different than it is for an ACA Marketplace plan for those under 65. Even then, I don't think ACA compliant plans such as those on the Marketplace specify which specific vaccines are covered. (Some still may not be in with the "Shingrix at 50" thing, but still with the older "Zostavax at 60".)

My practical experience has been that newer vaccines such as Zostavax when it came out and Shingrix when it came out, is that they often aren’t covered at first. The insurance companies drag their heels as they wish. Fortunately in both cases I happened to wait long enough to be covered. For the Zostavax, that was not covered for under 60 for a long while after the CDC or whomever gave the go ahead. I think DH paid for his a year or two before I went for mine. The Shingrix - they took a long time to cover it.

[ziggy29]

Quote:

Originally Posted by audreyh1 My practical experience has been that newer vaccines such as Zostavax when it came out and Shingrix when it came out, is that they often aren’t covered at first. The insurance companies drag their heels as they wish. Fortunately in both cases I happened to wait long enough to be covered. For the Zostavax, that was not covered for under 60 for a long while after the CDC or whomever gave the go ahead. I think DH paid for his a year or two before I went for mine. The Shingrix - they took a long time to cover it.

I don't think my insurance had Shingrix fully covered until 2019. The 2018 formulary did not include it, probably since in part ACIP added Shingrix to their recommended list very late in 2017. But my insurance also specified no-cost preventative vaccinations that were recommended and approved by ACIP. Shingrix was added to the formulary in 2019, and the covered age was lowered from 60 to 50.

It's possible they did something mid-year in 2018, but I never saw it. I supposed I could have called to check, but by that time I just decided to wait until 2019 when the local pharmacy confirmed I was covered for it.

[candrew]

We received the first dose of Shingrx vaccine at no OOP cost on our ACA plans this past December. Next dose will be in mid-March.

DW started Medicare in January with Medigap plan G and Humana Part D drug plan. It will be interesting to find out if she will be subject to paying full freight for the 2nd dose or only half.

[nwsteve]

We were using Costco for filling an optical prescription and tried to use a GoodRX coupon but were told that since we had Plan D coverage on file we could not use the coupon.
This was about a year ago, anyone still running into this issue. Costco implied it was a Medicare rule.

[GrayHare]

My experience has been when GoodRX shows a decent savings, the pharamcy is out of stock on that item, or at least claims to be. I've found this to be the case at multiple pharmacies.

[REWahoo]

Quote:

Originally Posted by GrayHare My experience has been when GoodRX shows a decent savings, the pharamcy is out of stock on that item, or at least claims to be. I've found this to be the case at multiple pharmacies.

Never run across that situation. Had my choice on two occasions last year of paying my Part D or the GoodRX price for a prescription at CVS.

[ivinsfan]

Quote:

Originally Posted by Bestwifeever Our Part D insurer does not cover the Shingrix vaccine but it does cover another one (Zostavax, I think). DH got revaccinated with Shingrix out of pocket (with a GoodRx coupon that took off maybe $40) when his doc recommended it; I'm okay with the Zostavax shot I got a few years ago.

JMO but the stats on the declining effectiveness of Zostavax with time are proven. I just paid OOP for Shingrix at 66.

[ivinsfan]

I tried to get mine under ACA but could not find it available in 2018.. Still long waiting list locally..

[anethum]

Quote:

Originally Posted by ivinsfan JMO but the stats on the declining effectiveness of Zostavax with time are proven. I just paid OOP for Shingrix at 66.

I posted this previously in the Shringrix thread:

A study by Kaiser using data from their large population of patients in northern California showed that after 8 years, the Zostovax vaccine still had an effectiveness rate against shingles of 31.8%.

https://www.ncbi.nlm.nih.gov/pubmed/29309521

FWIW, the Shingrix vaccine's effectiveness is thought to decline over time as well, but it starts at a much higher rate of effectiveness.

- - - - - - - - -

My ill-fated single Shingrix shot was given when I was still on the ACA and I paid nothing (but I've paid a helluva lot for my treatment following the severe side effects I experienced). The pharmacist told me that I would have to pay $200 for my 2nd Shingrix shot (which I will not be getting) after I started Medicare.

I'm not currently taking any prescription drugs, so I picked the cheapest Part D plan when I began Medicare last year. From what I can tell, Part D essentially useless for a significant percentage of the Medicare population.