Part B Rx

[bill3173]

I have a client that takes a tacrolimus and another Immunosuppressant, which are covered under part B at no additional cost. She is interested in getting an MA plan. I explained to her the difference in MA vs original Medicare, but she didn't really grasp the idea that she will have copays for these part b drugs.

Before I start the hang up and call back with the carriers; does anyone know if these Part B Rx are handled differently, than what is indicated on Medicare.gov?

 

[sman]

I have a client that takes a tacrolimus and another Immunosuppressant, which are covered under part B at no additional cost. She is interested in getting an MA plan. I explained to her the difference in MA vs original Medicare, but she didn't really grasp the idea that she will have copays for these part b drugs.

Before I start the hang up and call back with the carriers; does anyone know if these Part B Rx are handled differently, than what is indicated on Medicare.gov?

Are you asking if Medicare Part B Rx is handled differently on MAPD's? Most (all) plans in my area have a 20% coinsurance charge for Medicare Part B drugs.

 

[bill3173]

Yeah, wasn't sure when she was adamant that she could go to the MA plan and pay nothing for them. Just wanted to see if there was something else regarding these immunosuppresant drugs, that I was missing.

 

[kak6407]

On a MAPD plan she will pay 20% for these. My assumption is, whatever the MOOP on that MAPD plan is it will be reached very soon.

 

[bill3173]

On a MAPD plan she will pay 20% for these. My assumption is, whatever the MOOP on that MAPD plan is it will be reached very soon.

Actually, it's not that bad. We're looking at $700 total on Humana and $900 on Uhc. She just wasn't getting the fact that she would have to pay for them.

 

[kak6407]

Actually, it's not that bad. We're looking at $700 total on Humana and $900 on Uhc. She just wasn't getting the fact that she would have to pay for them.

Interesting. Curious how you got those numbers from 2 different carriers without a claim being submitted?

 

[bill3173]

Interesting. Curious how you got those numbers from 2 different carriers without a claim being submitted?

In addition to the Rx calculator on Medicare.gov, each carrier that offers Medicare Plans, that include Rx, has a formulary with fixed Rx for whichever period that you are researching, and usually an online calculator of their own.

The copays for non specialty Rx are listed and usually a fixed percentage, for specialty drugs, with known underlying cost.

In this case, after reviewing the corresponding cost for the Rx generated on the Medicare site, I called the carriers to review and confirm the prices.

 

[kak6407]

In addition to the Rx calculator on Medicare.gov, each carrier that offers Medicare Plans, that include Rx, has a formulary with fixed Rx for whichever period that you are researching, and usually an online calculator of their own.

The copays for non specialty Rx are listed and usually a fixed percentage, for specialty drugs, with known underlying cost.

In this case, after reviewing the corresponding cost for the Rx generated on the Medicare site, I called the carriers to review and confirm the prices.

I know all this but I thought you were talking about a Part B administered drug not one that is on a carriers Part D formulary