Silver Script SmartRX PDP

[Slade]

I enrolled in the Silver Script SmartRX plan for 2021 because the Medicare Drug Plan Finder calculated it as having the lowest total annual cost by a mile.

My real life experience matched the plan finder's calculations to the penny, paying just $14.03 full retail cost each month for my 4 generic medications at my local standard retail pharmacy.

Then on October 1st everything changed. Even though the 2021 Medicare Drug Plan Finder still shows $14.03 for all 4 of my medications, the Silver Script SmartRX drug plan and the pharmacy now quote $91.98 for the same 30 day supply.

This SS Smart plan is still coming up on the plan finder as my best option for 2022, still quoting $14.03 per month.

It isn't just me and it isn't just my pharmacy. I have heard from dozens of upset clients who are using varying pharmacies. When I call SS for an explanation, even after getting bumped up to the third level supervisor, they simply make up a BS story that the drug manufacturers raised their prices. Right, all pharmaceutical companies raised their prices on all tier 1 and 2 generic drugs 697% on October 1.

I will never enroll another client with SS.

 

[billyb]

I lost my book of SilverScript so this AEP every client will be moved. I too am done with SilverScript.

 

[goillini52]

I lost my book of SilverScript so this AEP every client will be moved. I too am done with SilverScript.

Damn, you got screwed again?!

 

[somarco]

Even though the 2021 Medicare Drug Plan Finder still shows $14.03 for all 4 of my medications, the Silver Script SmartRX drug plan and the pharmacy now quote $91.98 for the same 30 day supply.

Did you price those same med's with GoodRx?

 

[LostDollar]

Damn, you got screwed again?!

My guess is that he is talking about the previous situation and saying he is going to make changes this year because of it.

 

[goillini52]

My guess is that he is talking about the previous situation and saying he is going to make changes this year because of it.

I believe Billy is saying that someone screwed him out of his SilverScript book of business, so he's going to rewrite them with another carrier(move them from SS to a different carrier).

 

[Slade]

Did you price those same med's with GoodRx?

The pharmacy is filling their SS customer's prescriptions through GoodRx as a temporary solution. I could recommend that my clients move to a preferred pharmacy but I can't undercut my local pharmacy whom I have a good working relationship with in regard to referrals etc. We also have to support the local small town drug store or they will suffer the same fate of the small town hardware store.

My whole point is how extremely frustrating and aggravating it is to have a Medicare PDP plan completely pull the rug out from under their customers 9 months into the plan year. I guess they are not worried about their star ratings or even worse, getting sanctioned again.

 

[somarco]

The pharmacy is filling their SS customer's prescriptions through GoodRx as a temporary solution. I could recommend that my clients move to a preferred pharmacy but I can't undercut my local pharmacy whom I have a good working relationship with in regard to referrals etc. We also have to support the local small town drug store or they will suffer the same fate of the small town hardware store.

My whole point is how extremely frustrating and aggravating it is to have a Medicare PDP plan completely pull the rug out from under their customers 9 months into the plan year. I guess they are not worried about their star ratings or even worse, getting sanctioned again.

It's probably not the fault of the PDP

Your plan may raise the copayment or coinsurance you pay for a particular drug when the manufacturer raises their price, or when a plan starts to offer a generic form of a drug, but you keep taking the brand name drug.

Copayment/coinsurance in drug plans | Medicare

You can also research mid-year formulary changes.

I understand and appreciate your support for local business. I do the same when possible, but at some point you have to protect your client base. If the pharmacy wants to extract a pound of flesh because you are looking out for your clients, they need to get an attitude adjustment.

You can't save the world but you can do what is necessary to protect your client base.

 

[goillini52]

It's probably not the fault of the PDP

Your plan may raise the copayment or coinsurance you pay for a particular drug when the manufacturer raises their price, or when a plan starts to offer a generic form of a drug, but you keep taking the brand name drug.

Copayment/coinsurance in drug plans | Medicare

You can also research mid-year formulary changes.

I understand and appreciate your support for local business. I do the same when possible, but at some point you have to protect your client base. If the pharmacy wants to extract a pound of flesh because you are looking out for your clients, they need to get an attitude adjustment.

You can't save the world but you can do what is necessary to protect your client base.

I've noticed a few fluctuations. They should have to negotiate prices for the entire year and have to stick to them. Those crooked pharmaceutial companies make enough as it is.

I also try to support the 1 pharmacy in our little town. I like the fact that they deliver. But they don't take GoodRX, they aren't Preferred and they started requiring masks again. Screw 'em. I'll drive 10 miles to go to CVS or Walmart.

 

[kgmom219]

Based on my previous life, when I worked for a PBM (so naturally, I already KNOW that they are full of crap), here's what happened:

1. The local pharmacy is probably part of some type of co-operative for both contracting and purchasing
2. The contract with SS may have changed. The standard contract is X% of Average Wholesale Price + Dispensing Fee. This is why costs vary significantly. If the AWP is $100, they should get $87. But if there the acqustion cost is lower (helllloooo Kroger, Walmart, CVS, etc), then that's reflected in the consumer cost, especially during the deductible, gap and catastrophic phases
3. Their acquisition cost skyrocketed

That's not an SS issue. That's a pharmacy issue but they aren't going to throw the pharmacy under the bus, either