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Medicare Open Enrollment 2021 BE AWARE

I have become dismayed with the Medicare Plan Finder and in some cases the drug companies too.  The main issue is that I cannot count on the Plan Finder for Medicare to be correct.  I am not talking about estimated pricing, I know of that.  I have discovered that the price quoted for a drug on the plan finder does not match the drug company cost for the drug by as much as hundreds of dollars. (This is not just me but others I know have had similar problems)

 

Until last year the plan finder could be counted on as being right, now I have no confidence.  To over come this very disappointing turn of events, I tried checking the drug company website for the drug price but some did not provide any pricing and some were difficult to use.   It appears that I am going to have to call the company to get the drug price. 

 

What a shame that a good plan finder was reinvented to not work.  Bottom line, you can use the plan finder for possible companies but then call the company to be sure the prices are right.  I know what I am doing and I feel sorry for those who do not.  Be Aware and don't get caught by surprise when you go to the pharmacy to pickup your drug.

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Lot of companies market plans with alot of lip service aka puffing in the used car business, that is because the government and other consumer groups let them get away with it.  If not in writing do not believe what is said. I use the used car business as a example because that is what Medicare open enrollment reminds me of, and organizations like AARP are not really Policing  the issue, but they talk a good game.

 

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The  comments that have been made are basically on target.  I have heard that CMS claims that the issues with drug pricing should be corrected by October 26.  We will be checking and hoping that is correct.  This should include Cigna and ExpressScripts.  I certainly hope so as this has delayed people's help at least two weeks.

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Honored Social Butterfly

@l993995l 

 

I knew there was a lot of problems with the Medicare Plan Finder for Prescription Drug plans last year but I haven't heard or read about any problems yet for this year - your post was the 1st.  that I have heard about it.  But it is realtively early in the process.

 

I don't have to use it so I cannot help but @somarco is one of the AARP ACE's (right hand side of this screen - (See "YOUR ACEs) - you might send him a PM to see what he may know or if he has other suggestions as to how to compare that is not terribly time consuming.

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
Bronze Conversationalist

@GailL1 I knew there was a lot of problems with the Medicare Plan Finder for Prescription Drug plans last year but I haven't heard or read about any problems yet for this year - your post was the 1st.  that I have heard about it.  But it is relatively early in the process.

 

 

 

The "new" plan finder is marginally better than the revision 2 years ago, but still sucks.

 

As of today (10/19) Cigna and ExpressScripts have notified agents their Rx formulary and copay data is corrupted and useless. SUPPOSEDLY this should be corrected soon.

 

Word last week was to wait until after 10/20 to see data on those carriers and enroll.

 

There may be other issues.

 

I use Envision (Elixir in 2021). Their drug pricing mechanism is dysfunctional, at least on the few med's I checked.

 

Calling carriers MIGHT help but I have heard that some carriers (SilverScript) also has different information than is found on Mcare.gov

 

Medicare, Q1Medicare and most if not all of the independent sites rely on data submitted by the carriers. Both Medicare & Q1 have been having the same problems.

 

All the independent drug plan finders rely on the carriers so my suspicion is you won't find what you need for a few days . . . possibly into next week.

 

We have until 12/7 to enroll. Hopefully we can all get useful answers by next week.

 

 

@cougarlinz  Medicare doesn't pay the same a person would pay out of pocket for the medication. CMS negotiates the prices. 

 

Nope.

 

I don't know where this rumor got started but it isn't true.

 

Medicare does not negotiate drug prices. The $$$ given to the drug plan carriers by CMS is for subsidizing catastrophic coverage.


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I don't think the prices are supposed to match the company prices. Medicare doesn't pay the same a person would pay out of pocket for the medication. CMS negotiates the prices. 

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You are correct that CMS does negotiate pricing so the prices on the Medicare Plan Finder should match the drug prices that were negotiated.  The problem arises in that the prices negotiated can be different between drug companies for those on Medicare. A Medicare client will sign in as a Medicare client so the Medicare prices should  show up as matching. That was a very valid point. Thanks for pointing it out.

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CMS (Medicare) does NOT negotiate the prices of medications covered under Part D.  That is the insurers responsibility in developing their own formulary.  CMS (actually the law) does give the parameters of coverage - how many in each drug class an insurer has to include or if all of them in certain classes.

 

The Medicare Modernization Act of 2003 (MMA), the law that established the Part D benefit, includes a provision, the 'noninterference" clause, which stipulates that the HHS Secretary “may not interfere with the negotiations between drug manufacturers and pharmacies and PDP sponsors, and may not require a particular formulary or institute a price structure for the reimbursement of covered part D drugs.” In effect, this provision means that the government can have no direct role in negotiating or setting drug prices in Medicare Part D.

 

The Medicare Prescription Drug benefit  is provided through a marketplace of private plans that compete for business based on costs and coverage. Medicare contracts with private plan sponsors to provide a voluntary prescription drug benefit, and gives plans authority to negotiate drug prices with pharmaceutical companies, establish formularies, and apply utilization management tools to control costs, like Quantity Limits, Step Therapy and Prior Approval on specific, usually expensive drugs or those that need added safety controls. 

 

This approach contrasts with how drug prices are determined in some other federal programs, such as mandatory drug price rebates in Medicaid or the way drug prices and formularies are developed and handled in a national formulary associated with the Dept of Veteran Affairs.

 

CMS (Medicare) DOES negotiate those drugs that are covered under Part B.

Medicare Part B Outpatient Drug Coverage 

It's Always Something . . . . Roseanna Roseannadanna
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Part D drugs are negotiated by PBM's, not CMS. Pricing varies greatly by the pharmacy you use.

 

AARP MedicareRx Walgreens (PDP)
Plan type: Drug plan (Part D)
Plan ID:S5921-392-0

 

KROGER PHARMACY Standard in-network pharmacy
WALMART PHARMACY 10-0937 Out-of-network pharmacy
CVS PHARMACY #02107 Standard in-network pharmacy
WALGREENS #5447 Preferred in-network pharmacy

 

KROGER PHARMACY - Drug costs during coverage phases
Standard in-network pharmacy

Selected drugs Retail cost Cost before deductible Cost after deductible Cost in coverage gap Cost after coverage gap
Dorzolamide / timolol 22.3-6.8mg/ml solution $59.89 $59.89 $47.00 $14.97 $3.70

 

WALMART PHARMACY 10-0937 - Drug costs during coverage phases
Out-of-network pharmacy

You may have to pay the full cost for drugs. Choose an in-network pharmacy to get drugs at a lower cost.
Selected drugs Retail cost Cost before deductible Cost after deductible Cost in coverage gap Cost after coverage gap
Dorzolamide / timolol 22.3-6.8mg/ml solution $24.00 $24.00 $24.00 $24.00 $24.00

 

CVS PHARMACY #02107 - Drug costs during coverage phases
Standard in-network pharmacy

Selected drugs Retail cost Cost before deductible Cost after deductible Cost in coverage gap Cost after coverage gap
Dorzolamide / timolol 22.3-6.8mg/ml solution $60.14 $60.14 $47.00 $15.03 $3.70

 

WALGREENS #5447 - Drug costs during coverage phases
Preferred in-network pharmacy

Selected drugs Retail cost Cost before deductible Cost after deductible Cost in coverage gap Cost after coverage gap
Dorzolamide / timolol 22.3-6.8mg/ml solution $60.59 $60.59 $40.00 $15.15 $3.70

 

 

Above pricing from the Medicare PF.
 
Don't ask me why an out-of-network pharm has better pricing than in-network preferred.

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