Might need your thinking cap for this one...
Had an appointment yesterday and the client asked me when they would hit the donut hole.
Prescription: Quetiapine
Current PDP retail price (in-network pharmacy): $54 co-pay $38
Proposed MA retail price (in-network pharmacy): $233 co-pay $6
Actual retail price at the same pharmacy: $670
My question is... How are the retail prices for the prescription determined? I called Medicare and the plans and nobody could provide an answer.
Obviously this is a very important question since the retail price of the prescription determines when they will, or if they will, reach the donut hole. On the current plan, they will not. On the proposed plan they would reach it in Sept. The decision was a "no-brainer" to leave things be and avoid the donut hole, but how can there be such a discrepancy between the retail prices?
Had an appointment yesterday and the client asked me when they would hit the donut hole.
Prescription: Quetiapine
Current PDP retail price (in-network pharmacy): $54 co-pay $38
Proposed MA retail price (in-network pharmacy): $233 co-pay $6
Actual retail price at the same pharmacy: $670
My question is... How are the retail prices for the prescription determined? I called Medicare and the plans and nobody could provide an answer.
Obviously this is a very important question since the retail price of the prescription determines when they will, or if they will, reach the donut hole. On the current plan, they will not. On the proposed plan they would reach it in Sept. The decision was a "no-brainer" to leave things be and avoid the donut hole, but how can there be such a discrepancy between the retail prices?