Part D 2022

[kgmom219]

Humana Walmart Value Plan

I am not able to match Humana website pricing for Hydrocodone 7-325 and 10-325 with planfinder pricing.

I have a local pharmacy which we need to use for an extended family member. Plan finder shows it out of network on the Humana Walmart plan, with a cost of $10,000 on the med list.
The Humana website shows it as a standard pharmacy with standard pharmacy pricing of only $1,000.

No idea if that type of issue would carry over to any of the national or regional pharmacies.[/QUOTE


Make sure you are using the right ingredient (acetaminophen or ibuprofen)

And Walgreens is always your best answer for CII's. What's AARP look like?

 

[LostDollar]

What's the Zip and which one? Is it hydrocodone/acetaminophen and which strength, 7 or 10?

Patient is on 24/7 Hospice home care.

My drug list and related quantities is very much an estimate sifted out of current med records from pharmacy.

It is currently a list of 8 meds, including 2 Hydrocodone/Acetaminophens -7-325 and 10-325.

I ran that on CMS for 5 pharmacies. The reports led me to results for Humana and SilverScript. I then went to Humana and SilverScript's websites and ran listings for the same 8 meds and 5 pharmacies. The Humana (WalMart Value) and SilverScript (Choice) website annual drug and med totals for a standard network pharmacy are both different from the CMS annual totals for the same plans.

As nearly as I can see, the difference comes from CMS having a higher total for Hydrocodone/Acetaminophen 10-325 than the carrier websites have. The SilverScript difference for a standard network provider was around $120. The Humana difference was not quite as large.

HOWEVER, when I try to test using only a list of two drugs, say Amitryptiline HCL-90 for 30 days and Hydrocodone/Acetaminophen 10-325 - 60 for 30 days and put in only two pharmacies-1 preferred and 1 standard, I cannot duplicate the variance.

So I think my original comment has to be ignored at this time since I can't get to a consistent verifiable CMS variance error, but I will make judgements for my specific situation based on what I think of the carrier data I have. I am not going to take the CMS data.

 

[Millwood]

All the pain management meds should be covered by Hospice with no more than a $5 copay.

 

[LostDollar]

edit
@kgmom219 my quoting you didn't come through
end edit

Thank you. (What is CII?)

Patient is on 24/7 Hospice home care. A couple of years ago my wife located a specific local compounding pharmacy that puts meds in individual dispensing packets as well as delivering. With 5-7 home care staff, this packaging has significantly reduced the number of medication administration issues.

The specific pharmacy location I am looking at (It must be a compounding and packaging warehouse) does not show on CMS for any Humana plans, but but it does show on the Humana website as standard network provider. It shows in SilverScript as a standard network provider.

Once I deal with that for CMS quote purposes by using one of the compounding pharmacy's retail locations that CMS has for all carriers, In round numbers I get $1000 total annual cost for SilverScript and $1300 (rather than $10K) for Humana. (The do nothing Cigna option for 2022 would be $2300 for the same list.) I think the AARP options were higher, but don't remember for sure.

(I only made this post to not ignore your help. Please don't send out one of those big Ford vans full of Texas CowBoy Hats to administer hijacking discipline! I'm worried, because the way Texans drive they could be up here and back there for the supper team meeting at Red Robin in the same day.)

 

[LostDollar]

All the pain management meds should be covered by Hospice with no more than a $5 copay.

Thank you for the comment. I am too far away from details of this to know how Hospice works. Just trying to help my wife make a responsible evaluation of patient's PDP for 2022. Please let's not do any more of my specific situation details in this thread. I don't want my comments or questions to mess up the flow of this thread. If there's more stuff I should know about hospice and drugs we can figure out another thread to talk about that in.

 

[kgmom219]

Thank you for the comment. I am too far away from details of this to know how Hospice works. Just trying to help my wife make a responsible evaluation of patient's PDP for 2022. Please let's not do any more of my specific situation details in this thread. I don't want my comments or questions to mess up the flow of this thread. If there's more stuff I should know about hospice and drugs we can figure out another thread to talk about that in.

CII is the DEA drug classification. AKA Class 2.

These are the drugs that require a DEA number to prescribe and fill and can only be filled for 30 days, no refills, etc. BUT. The rules are different for Hospice and they handle it.

Fun Fact: State Medical Boards do not require a DEA number for other prescriptions, just controlled drugs, CII to CIV. (Xanax is controlled, but doesn't require the special dispensing rules. Lisinopril requires a prescription, but isn't controlled).

The reason the DEA numbers are required for non-controlled meds is for the PBM. So the PBM can produce the data for the drug manufacturer. And the drug manufacturers may or may not use the info to pay their reps. Yell at the reps. Or perhaps send invites to conferences to docs that write enough of a certain drug. Maybe. Perhaps.

 

[kgmom219]

WHAT THE HECK IS GOING ON WITH SYMBICORT???

(Yes, I'm yelling. WTAF)

 

[kgmom219]

Adding Urisdol to the GoodRX list

 

[kgmom219]

Adding Olmesartan and Trospium ER to Good RX list. And on both look at 90 day and 6 month supply

 

[kgmom219]

Adding this whacked out (pun intended) drug to whacked list

Invega 234mg/1.5ml suspension prefilled syringe

If they are on the pill, generics are available. If they are on the injection, use brand at Medicare.gov. There's no generic injection.