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Recognized Social Butterfly
Posts: 872
Registered: ‎09-03-2011

Re: Prescription Plan

Message 1 of 4 (1,057 Views)

Contact the Texas SHIIP, Senior Health Insurance Information Program. Every state has a SHIIP paid for with our federal taxes. It’s free to you. Their job is to help walk you through and understand Medicare and the various supplement plans. Also they explain Medicare advantage plans and Prescription Drug Plans. They are the best advocates a senior can have when dealing with Medicare in your state.

Valued Social Butterfly
Posts: 991
Registered: ‎01-02-2012

Re: Prescription Plan

[ Edited ]
Message 2 of 4 (1,065 Views)



Gail1 wrote:

 

So what kind of plan is this?

Is Imitrex covered on the formulary - it could be under its generic name too. 

( GENERIC NAME: sumatriptan succinate )

Are all of his other meds on the formulary?

Are there any med qualifications for it?  

Are the injections done at home or at the doc office?

If he is on Medicare and this is a Medicare Part D plan, have you already reached the donut hole for 2016?

 

 

dr6182

 

Gail did a great job of laying out key questions that would need to be answered if you wanted some advice (and if you just wanted to vent, that's OK too). I would add to Gail's list

 

-- What in your opinion does your recent move to Texas have to do with the situation (did you previously live elsewhere and the prices were less expensive? did that other place have a state pharmacy assistance program?)

-- It seems incredible that a healthcare policy is not paying anything "for any prescription" your husband takes . The odds would be astronomical that a drug policy would cover nothing. (Are you talking perhaps about a so-called private, state-regulated Medigap policy from Untied?)

-- Who is arguing with what doctors? (Doctors where you used to live or new doctors in TX or...? Typically the problem is that doctors won't go to bat for people on these types of issues

-- What in your opinion does AARP have to do with the situation (maybe you just mean that you have an AARP branded insurance policy?)

 

 

 

 


Valued Social Butterfly
Posts: 8,795
Registered: ‎08-18-2008

Re: Prescription Plan

[ Edited ]
Message 3 of 4 (1,109 Views)

dr6182 wrote:

Recently moved to Texas.  Untied HC has not paid a single dime for any prescriptions my husband is taking.  He is a chronic migraine sufferer for the past 20 years.  He is on disbility and 50% of his income is to pay for the prescriptions they said they would covered and have not.  High blood pressure, anti seizure medication, preventatives for migraines, immitrex injections, immitrex pills and pain killers.  After I specifically named each and every single prescription 3 times they told me what my co pay would be.  To this day I am paying out of pocket 979.00 a month.  NOTHING is covered. Why did they lie and why are they continually arguing with the doctors that my husband should be taking excedrin or aspirin.  Help migraine sufferers.  My husband has been in bed 3 days no eating, drinking fluid and constant vomiting.  Aspirin is not the answer.  Aarp has no clue


Yes, dr6182, severe migraines can be very debilitating.  

 

You did not say if your husband's prescription drug plan with UHC is a Medicare policy and if so, is it a freestanding drug plan or one within a Medicare Advantage plan. Or perhaps this is another type plan all together?

 

I will assume that this policy was written under Texas or changed when you moved.

 

Prescription drug plans work by formularies of what meds are covered and how they are covered in their stipulations and any out of pocket cost.  They also usually give several places where you can get the best price when purchasing them like using a mail order or a preferred pharmacy.

 

All these details and more should have been sent to you when you picked the plan. It is very important to understand the complete workings of the plan and the medications in their formulary so that you can know if this is the best plan for your husband's needs.  If this is a Medicare Part D plan, it is also good to know how the program works with your choice of Prescription Drug insurers.  There is also a grievance process with Medicare.

 

So what kind of plan is this?

Is Imitrex covered on the formulary - it could be under its generic name too. 

( GENERIC NAME: sumatriptan succinate )

Are all of his other meds on the formulary?

Are there any med qualifications for it?  

Are the injections done at home or at the doc office?

If he is on Medicare and this is a Medicare Part D plan, have you already reached the donut hole for 2016?

 

If this is a Medicare Part D plan, open enrollment begins very soon and you will have a chance to change plans after researching which plans are available where you live and which covers all his meds and at what cost.

A little later on in the year when open enrollment starts for 2017 coverage, you can use the Medicare Find A Drug Plan to help you with your research.

 

You might be just coming here to grip or you might be looking for some help.  It is unclear from your post.  But for help, a few more details are needed ( see questions above).

 

 

 

 

Info Seeker
Posts: 1
Registered: ‎08-18-2015

Prescription Plan

Message 4 of 4 (1,138 Views)

Recently moved to Texas.  Untied HC has not paid a single dime for any prescriptions my husband is taking.  He is a chronic migraine sufferer for the past 20 years.  He is on disbility and 50% of his income is to pay for the prescriptions they said they would covered and have not.  High blood pressure, anti seizure medication, preventatives for migraines, immitrex injections, immitrex pills and pain killers.  After I specifically named each and every single prescription 3 times they told me what my co pay would be.  To this day I am paying out of pocket 979.00 a month.  NOTHING is covered. Why did they lie and why are they continually arguing with the doctors that my husband should be taking excedrin or aspirin.  Help migraine sufferers.  My husband has been in bed 3 days no eating, drinking fluid and constant vomiting.  Aspirin is not the answer.  Aarp has no clue