The mysterious Part D

[Tybee]

Yesterday I picked out my new Part D plan and boy, it's a crapshoot. Last year I was paying 38 dollars a month and my medicine was unaffordable. That plan was going up to 42 dollars a month. I looked at five plans and ended up going with the cheapest per month as that was also the cheapest for my albuterol inhaler. But generally, it's cheaper to just buy the inhaler with Good RX.

I am so confused. The plans range from 4.60 to 70 dollars, and the medicines all seemed to cost the same. When I put in the advair generic that she wants me to take, the cost per year was up to 8000 on one of the plans. The cheapest was around 180 a month plus the premiums. I told the doctor when she prescribed it I didn't think I could afford it, and she said, Oh, it's fine, I checked, you're covered. Then when I went to pick it up, they wanted 450 dollars. So I gave up on that medicine as cannot afford it.

I know you have to have a plan to avoid the penalty being tacked on. So I signed up for the cheapest, the 4.60 plan. But I wonder what it will cover. You'd think the more expensive plan would cover more. But that was not really my experience last year.

What if you get sick and need medicines you don't know you need?

Finally, when I was in the hospital, I had to fill the pain med prescriptions there and we paid 24 dollars for both. But then on my billing, it shows up only that I paid 8 dollars for the one.

I am so confused. How in the world are you supposed to choose when you don't know what you will need? My husband's barber is on medicine for his arthritis that is 3500 dollars a month. I can't remember what they cover.

[catherine]

You will never know, because drug formularies change constantly, depending upon annual negotiations between manufacturer, CMS, and pharmacy benefits people. Thankfully most classes of drugs have options allowing you to choose a generic, or a preferred brand, or a non-preferred brand.

[catherine]

Also, Tybee, have you gone to this website? https://www.medicare.gov/plan-compare/?utm_source=google&utm_medium=paid_search&utm_campaign=pn-cmsoe2022-gm&utm_term=trafficdriving&utm_content=pn10152022_medicare-part-d_rsa8&gclid=CjwKCAiApvebBhAvEiwAe7mHSMTOcGgtIkixGUq5uUsJ PnX3jjfIZvqXScMQwdroMbNrYMPsmVaQrhoCIswQAvD_BwE#/?year=2023&lang=en

You can pick the drugs you are currently on and see what the best option is in your area. Doesn't predict the future but it does help when trying to choose a Part D plan now.

[Tybee]

Also, Tybee, have you gone to this website? https://www.medicare.gov/plan-compare/?utm_source=google&utm_medium=paid_search&utm_campaign=pn-cmsoe2022-gm&utm_term=trafficdriving&utm_content=pn10152022_medicare-part-d_rsa8&gclid=CjwKCAiApvebBhAvEiwAe7mHSMTOcGgtIkixGUq5uUsJ PnX3jjfIZvqXScMQwdroMbNrYMPsmVaQrhoCIswQAvD_BwE#/?year=2023&lang=en

You can pick the drugs you are currently on and see what the best option is in your area. Doesn't predict the future but it does help when trying to choose a Part D plan now.

Thanks, Catherine, yes, that's where I went and where I was getting my figures from for the different plans. The good thing about doing it there is I am going to have the payment deducted from my social security payment.

[flowerseverywhere]

Try GoodRX website. you plug in drug and area and it shows you what various grocer and Independent pharmacies in your area would charge under their free plan. you wou!d be surprised. We can get generics under our medicare almost free by getting three months at a time, but some are more expensive. Say one med using goodRx could be
$5 at walmart, $14 at Walgreens and $21 at the grocer. Then the next would be cheapest at the grocer. DH actually goes to a grocer and Wal-Mart for two drugs he on and gets mail order from our Medicare for the third. It is just nuts.

Some of.our friends get theirs from Canada by mail, and I've heard of people going to Mexico for insulin. there actually is a Canadian pharmacy in the next town, but I'm in Florida where there are lots.of old people who take meds.

[Tybee]

Thanks, Flowers, I had not thought to look up the Advair on GoodRX--great suggestion!

Leaving the country for affordable medication is not on my horizon at this time, but if I were getting around better and there was a way to do it, I would certainly try it.

[Tybee]

Ok, the generic on Good RX for Advair ranges form 103-210 per month.

[Tybee]

Catherine, my feeling is that the healthcare/pharma system really wants people with asthma to die, because they make the medicine unaffordable, and then they won't have to pay for things like emphysema later on. That's just my feeling, though. They never shared that with you, did they?

[flowerseverywhere]

Thanks, Flowers, I had not thought to look up the Advair on GoodRX--great suggestion!

Leaving the country for affordable medication is not on my horizon at this time, but if I were getting around better and there was a way to do it, I would certainly try it.
Leaving the country is not in our wheelhouse either. I know Canadian meds are available by mail. Maybe someone will chime in with one they know is good. Ill ask around. I have lots of old friends.

Also I'm glad GoodRx might be helpful. And I wonder sometimes, like you do if insurance plans make it hard so their high needs customers will choose a different insurer or die. You know those big shiny buildings with all the high paid execs need to make money. They have shareholders to please and bonuses to make.

[catherine]

Catherine, my feeling is that the healthcare/pharma system really wants people with asthma to die, because they make the medicine unaffordable, and then they won't have to pay for things like emphysema later on. That's just my feeling, though. They never shared that with you, did they?

No, they don't want people to die because then they lose the revenue stream from those patients. Chronic illness is money in the bank for them. Look what they did with insulin--they pushed that price up until the government intervened. The profit motive gets in the way of the good of the people.

[rosarugosa]

I just did the Medicare.gov comparison for my Mom's part D plan. She has a BC/BS Medex plan that costs almost $2800 per year (in addition to the original Medicare premium), and her prescription plan is with them too. This year, her out of pocket for meds is over $1800, so I felt like I needed to check alternatives. It appears that with no change in plans, her meds would cost over $2700 next year! I switched her to an AARP plan that predicts a cost of about $1500.
I found it interesting that for both plans, mail order would cost slightly more than retail pharmacy. With my own current retiree health insurance through United Health & CVS/Caremark, we are definitely pushed to go to mail order for any long term meds, so I assumed this would be the most cost-effective choice with any plan, but apparently not.
It certainly seems like the whole thing could be less complicated.

[Tybee]

Rosa, I noticed that too, that the mail order was the most expensive, which did not make any sense to me. When I used to buy mail order asthma meds with regular insurance, it was the cheapest option with copays so I paid less.