Misleading Drug Cost Estimates

[woodbridge98]

For the second year in a row, I have found the "Estimated Drug Costs" information provided online for comparing Part D Plans to be way off the mark.  By way of example, for the six prescriptions I take regularly, according to the Medicare.gov and the AARP Medicare websites, under the Medicare Walgreens Rx plan, my estimated drug costs for 2022 will be $984.20. I currently have that plan, and my actual drug costs for those prescriptions as of today's date come to $1,942.12.  That is a difference of nearly $1,000 - and the year isn't over yet. The same thing happened to me in 2020. I have not reached the donut hole, nor did I last year, so that's not the issue.

I've spent hours on the phone speaking with representatives on the Medicare.gov and AARP helplines, and none of them provided any real explanation. The AARP person stated that according to my 2021 plan, I should have a co-pay of $30.20 per month for one of the drugs that I take. Last month, my co-pay was $102.60!  She confirmed that $102.60 was, in fact, the correct amount of the drug based on the drug's cost to the pharmacy, while continuing to tell me that the amount I should have been charged was $30.20. That's like saying 1= 3.

I realize that the amounts shown on the websites are only estimates.  Having actual drug costs that are more than double the estimated amount, however, renders those estimates meaningless.  How is one supposed to compare the costs of two plans side-by-side when the estimated costs provided by the insurer bear no relationship to reality?!

[krscott2006]

As an employee of an independant pharmacy, might I suggest you go into your pharmacy and speak with the pharmacist directly. Our staff, and many others are trained to review and explain plans and options. It one of the best perks of an independant pharmacy! The websites are full of so much information and not necessarily the best place for answers for each individual case. Calling your insurance helps however they can give you the same misleading information. We have found that when someone sits with a representative in our offices and can ask questions directly in regards to their medications and reimbursement the choices become clearer. We are not always their best choice and some patients must move their medications to other retail chains or mail order to keep cost within their reach. More importantly we know we give them the best chance of living healthy through their retirement years. Please call your local pharmacy and request a review, if they value you and your business they will be more than happy to assist! 

[john258]

Here is an example of what I encountered with my local Pharmacist with a problem.

My Dentist  gave me a mouth wash  prescription. I took it to my local pharmacy. Was told it would be ready by 3PM. They had to compound  it at the store.

3PM pick up time. Was told my Insurance Co. rejected the prescription. Needed it badly. Got price of over $100.00 retail. Had them check 2 discount plans I had, and one the county has. Cost was $17.00 which was close to what it would have been under my Insurance plan. Got the mouthwash.

Called my Insurance Carrier drug area. They had not rejected it, but said it was sent in with incorrect coding and requested it be corrected so they could approve it. They never got anything back from the local pharmacy. They told me it had to be locally compounded at the store, and that takes time so the pharmacist is busy tries to avoid it. The person I talked to on the phone with the Carrier had used this mouthwash and said how great it was and her insurance paid for it. Her Carrier and my Carrier were the same.

I was not told the truth by the pharmacist. Yes the store manager and I had a good discussion on this, and I had one with my Dentist about not being told the truth by the pharmacist. That should never happen.

My point is you can have problems at any level and should be prepared on what you would do. For me this all worked out ok, and I am sure the local store learned something.

[GailL1]

@woodbridge98 

I looked up the AARP MedicareRx Walgreens (PDP) in my area just so I could see what the plan design was but pass that it is hard to work through without details - but just some things that you can look at are:

1.  What is the deductible on the plan?  The one I looked up in my area has a deductible of $310 for tier 2-5, $ 0 for tier 1.     Is that the same for you for 2022 plan?   You have to get thru the deductible, if you have one, before the plan starts paying.  So, add that amount into your total drug cost.

2.  Your stated co-pay is an odd figure ($ 30.20) may I assume that it is a higher tier med thus it really isn't a copay but a % coinsurance

3.  I noticed on the example that I did on the plan you mentioned that some of the totals (by month) included the premium cost also.

4.  What type of pharmacy are you using?  (a) preferred Mail order, (b) preferred free standing, (c) standard retail in-network.   (d) standard mail order.  

Drug copays and coinsurance values are based on your pharmacy selection. Cost under this plan (the one I am seeing from my area) has a much higher price if you use a standard mail order pharmacy as compared to a preferred mail order pharmacy. (See my screen shot below)

 Then there is this:      (copy/pasted from the below screen shot)

Member may use any pharmacy in the network but may not receive the same pricing as Walgreens or Duane Reade, the plan's preferred retail pharmacies. Walgreens pharmacies may not be available in all areas. Duane Reade is only available in NY and NJ. Tier 2 copay,Tier 3 and Tier 4 coinsurance applies after deductible.

By using the Estimator on the Insurers website - you can do it by the med and see the cost as you build your list.

https://www.aarpmedicareplans.com/health-plans/estimate-drug-costs.html#/buildyourdruglist 

These are the plan details that I am seeing - I don't know if they are the same for you - are they?