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Info Seeker
Posts: 2
Registered: ‎12-06-2010

Re: Dissappointed with AARP's Medicare Rx Plan D provided by United Healthcare Insurance.

Message 1 of 4 (259 Views)

Thanks for all of the good information this forum has provided.  It is not satisfying to me as a consumer but it seems that there is no logic to the current state of affairs.  I appreciate the responses.

 

Dan

Valued Social Butterfly
Posts: 8,383
Registered: ‎08-18-2008

Re: Dissappointed with AARP's Medicare Rx Plan D provided by United Healthcare Insurance.

Message 2 of 4 (286 Views)

Here is the information on Drug coupons and why Medicare does not like them.

It is a little dated but I still think it fits today.  This is more about using coupons for specific brand meds but using discount coupons would have to be used based on the retail cost of the med and not the supposed discount price which people get through their Med D insurer.

 

It is all about the numbers - what it will cost you - the cheapest way for your pocketbook now and throughout the year if the drug is a maintenance med.

 

KHN 10/01/2012 - Drug Coupons: A Good Deal For The Patient, But Not The Insurer

 

from the link ~

In the past few years, coupons and discount cards have become nearly ubiquitous for prescription drugs. Such incentives are available for 395 medications, according to a recent report from industry consultant IMS Health. In a similar analysis in 2009, a marketing firm found that only 86 drugs came with coupons.

 

Drugmakers say the coupons help Americans get the medicine they need. But the insurance industry is concerned that they drive patients toward more expensive brand-name drugs, leaving insurers to cover the full cost, which then gets passed on to consumers in the form of higher premiums.

 

“An individual patient who receives a coupon might not realize that, although that particular prescription may cost less that month, overall what it does is to raise costs for everyone, including themselves,” said Susan Pisano, a spokeswoman for the industry trade group America’s Health Insurance Plans.

 

For people using Medicare, Medicaid, veterans benefits or any other federal health insurance program, using a coupon or a discount card to buy prescription medication works against efforts to keep federal spending down and may also be counter to federal law, according to some experts’ interpretation.

 

. . . .The cost issue surrounding coupons is made even more complicated when the federal government is the insurer.

 

According to federal statutes, it is a crime to provide “any remuneration to induce or reward referrals reimbursable by a federal health care program.” Some experts say coupons constitute such remuneration because they encourage consumers to purchase a more expensive product, with the extra cost ultimately falling on taxpayers. A 2010 report from the Congressional Budget Office found that Medicare pays an additional $76 every time a senior chooses a brand-name drug over a generic.

 

Even officials within the pharmaceutical and insurance industries said coupons should not be used by beneficiaries of government health programs. “The use of co-pay coupons is prohibited in the Medicare Part D program and pharmacies,” Bennett said, “and coupon-processing vendors have safeguards in place to prevent unauthorized use.”

 

But others say the coupons’ status is not resolved.

 

According to Donald White, a spokesman for the Department of Health and Human Services, no court or administrative body has ever ruled that coupons are illegal. HHS has never prosecuted anyone for issuing or using coupons in the federal health programs.

 

more at the link ~

Valued Social Butterfly
Posts: 8,383
Registered: ‎08-18-2008

Re: Dissappointed with AARP's Medicare Rx Plan D provided by United Healthcare Insurance.

Message 3 of 4 (302 Views)

Danshellist wrote:

I have been taking Metaxalone tab 800mg (generic for Skelaxin).  I pay (rough numbers) $300 and United pays $600, total cost about $900 for a 90 day supply.  Just discovered that I can buy the same prescription at Walmart with a free discount coupon for $300 total cost.  No out of pocket difference to me BUT, the extra $600 that United supposedly pays to OptimRx has been pushing me toward the "donut hole".  Why would AARP select a company that would charge 3X the price that is readily available for less.  Why would United be willing to pay OptimRx 3X the price that Walmart charges?  There is a rip-off somewhere in this pricing.   And, it took an act of congress to get United to approve the medicine.  My doctor had to send 3 letters explaining why he wanted just that med.  I'll be buying from Walmart or Costco from now on.

Dan


Because there is a benefits manager also in the mix in addition to you and the insurance company that takes a cut - Congress is trying to fix this mess.

 

AND also Because it is insurance and by its very name, you help pay for the medication needs of others, not just yours.

 

Normally, a person on Medicare Part D, if they know you have this insurance, cannot use a discount coupon.

Consumer Reports 03/27/2017 - Secret to Getting a Pharmacy Discount with Medicare

 

I will try to find the Medicare rule on using discount coupons when I can search better on another device.  I know I have posted it before here but it has been some Time ago.

 

I have also heard that many people are checking into GoodRx to see what the prices in your area they are finding.  They give prices using a coupon and also for different  Medicare Part D plans.

 

A lot of Part D plans don't cover Metaxalone according to GoodRx and they do have a pretty good reputation for keeping up with this stuff.  Did you pick this plan just because there was some coverage for it -  even though you seem to be covering a big part of the cost and paying the benefits manage.

 

GOODRX - Metaxalone 800 Mg tabs - Medicare and discount coupon price

 

 You can do your search on GoodRx by area to give you the best info.

Info Seeker
Posts: 2
Registered: ‎12-06-2010

Dissappointed with AARP's Medicare Rx Plan D provided by United Healthcare Insurance.

Message 4 of 4 (319 Views)

I have been taking Metaxalone tab 800mg (generic for Skelaxin).  I pay (rough numbers) $300 and United pays $600, total cost about $900 for a 90 day supply.  Just discovered that I can buy the same prescription at Walmart with a free discount coupon for $300 total cost.  No out of pocket difference to me BUT, the extra $600 that United supposedly pays to OptimRx has been pushing me toward the "donut hole".  Why would AARP select a company that would charge 3X the price that is readily available for less.  Why would United be willing to pay OptimRx 3X the price that Walmart charges?  There is a rip-off somewhere in this pricing.   And, it took an act of congress to get United to approve the medicine.  My doctor had to send 3 letters explaining why he wanted just that med.  I'll be buying from Walmart or Costco from now on.

Dan