Thursday, January 3, 2019

Take two pills and call me in the morning

On Medicare? If so, you likely have a Part D drug plan. It may be built into your Medicare Advantage plan or it may be a stand-alone drug plan. Either way, you need to be vigilant to avoid overpaying for your prescriptions. In other words, don't blindly hand over your Part D drug plan ID card at your favorite pharmacy and hope you are getting the best price.

I've been enrolling people to Part D drug plans since 2006 when the government first started this program. I've used my own Part D drug plans since 2012 and have some tips and hints to make your experience better. Let me give you an example of what I mean.

Two women walk into a local Bartell Drugs in Seattle to fill their prescriptions, both pulling out their Medicare Part D insurance cards. One pays $27, but the other writes a check for $153 for the exact same drugs. Unbelievable? Not really. In fact, it happens all too often. There are several ways to avoid this situation.

#1 - know your plan and make sure all of your regular doctor-prescribed medications are in the plan formulary. You should have received one with your plan but you can also look it up online.

Tip: some formulary documents are 160 pages long. To look up your prescription, press the Ctrl key + the F key. That opens a dialogue box in the upper right-hand corner of the document (usually a PDF). Type in the exact name of your medicine. There should be an indicator showing either 0/0 meaning the drug is NOT in the formulary, or 1/6 (it could be 1/10 meaning the drug shows up in six or ten places). If there are numbers in the indicator you should see the drug listed on the page it took you to. You can hit ENTER to jump to the next listing, and so on.

Notice the number next to the name of the drug indicating which TIER level it is assigned: 1, 2, 3, 4 or 5. Tiers 1 and 2 are usually labeled generic, tiers 3 and 4 are brand name drugs. Tier 5 is often an injectable or doctor-administered drug.

#2 - understand the three stages of drug coverage: The initial stage which may have an annual deductible and then low copays, the coverage gap (donut hole) stage with higher copays and finally the catastrophic stage when your costs are very low. Have your professional agent explain these stages to you so there are no surprises during the year.

#3 - there are alternatives to using your Medicare Part D drug plan. Check the coupons available at and see if there is a less expensive way to purchase the medicine. A client was paying $161 for a 90-day prescription at a compound pharmacy using her Plan ID card. She found that the same drug was available for $70 at the Safeway pharmacy. She saved $364/year by using GoodRx instead of her Part D card.

#4 - prices can vary from pharmacy to pharmacy. All drug plans negotiate special arrangements with certain pharmacies - called "preferred pharmacies" - that let them offer better deals in those stores. Again, your Drug plan booklet should list the preferred pharmacies. If not, call the customer service department and ask for the preferred pharmacies in your area. Also, check to see what the copays are for using your plan Mail Order service - it can save you money over buying locally.

#5 - use a professional insurance agent that has been trained and certified to offer Medicare health plans and Medicare drug plans. You do not pay for their assistance and buying a plan through an agent costs exactly the same as it does if you enroll online or over the phone. They get paid by the insurance company and the compensation is identical from carrier to carrier thus there is no incentive for the agent to favor one insurance plan over another.

#6 - follow the Medicare Star Ratings. The higher the Star-rating, the better. All companies seek the coveted 5-Star rating but Medicare is stingy on giving these out. Most companies are rated 3.5 Stars and a few earn the 4-Star rating.

#6 - you can make a change to a different Part D plan once a year. The Annual Election Period (AEP) runs from October 15 to December 7 when plan participants can switch plans. And read your Annual Notice of Change (ANOC) document that is mailed out in September. Look for any changes that need your attention.

If your agent hasn't reached out to you by October 15th, call/email or text him/her for a review. If you don't have an agent, contact my office. We always have time to help you find the right plan.