Silver Script SmartRX PDP

[mdlovell]

What I'm getting at is simplicity, simplicity, simplicity.

The summary of benefits for a PDP plan is actually quite simple.

Let then figure out what 23% of Spiriva will be. I'm tired of Medicare predicting $24.36 for Buproprion XL then Jane calling me mad that it was $37.34.

If I just send the summary of benefits... then Jane knows it's 23% (or whatever).

YMMV.

I like this idea a lot, I'm going to make this same adjustment moving forward now.

Thanks for the tip!

 

[sshafran]

I like this idea a lot, I'm going to make this same adjustment moving forward now.

Thanks for the tip!

It's helpful and another reason I like the search and save platform is that it has the Summary of Benefits "at your fingertips" on the screen.

Just did a PDP analysis for someone.

He's on non-preferred generic Rx - Lansoprazole Cap 30MG (also on HCTZ)

Current Plan: SilverScript Choice (Ohio)

WellCare Value Script is estimating 308/yr
SilverScript Choice is estimating $972/yr

Both have Lansoprazole as Tier 3

A rookie would recommend WellCare, and WellCare may indeed be better.

But WellCare is estimating Lansoprazole to retail "full cost" at $38.45 for 90-day. The copay for Tier 3 (summary of benefits) is $126, so the estimate says he would pay $38.45 because the "retail estimate is lower than the copay"

But I don't know what it retails for, and apparently, this info is next to impossible to find out without walking into a pharmacy in 2022. Can't time travel yet.

SilverScript Choice - 17% coinsurance.

After deductible, of course.

• So either an "estimated copay of $38.45, but up to $126" for 90-days
• or simply 17%.

He picked 17% and is staying w/ his plan.

Maybe he's missing out on paying $38.45, but my gut says that price is probably lower than reality.

 

[kgmom219]

I hear you, but I

Not sure how long ago it was but I recently stopped sending "illustrations," etc., from Medicare dot gov unless specifically requested (it never is).

I do send the summary of benefits.

This is what we actually are supposed to send, but it's rarely provided in lieu of a confusing, inaccurate "illustration" from Medicare.

I think it's helping. It might be little more vague as to "why this plan but not *that* plan" bit I no longer care to really back up the recommendation ad nauseum -- i.e. I'll say based on these Rx's, plan __ looks like a good fit.... but I've moved away from trying to predict the future or have them try.

I don't want the mechanic to explain to me why he is recommending xyz for my car. I don't want a diagram. If I trust him I trust him. Just ring me up.

I hear you, but I still send it. Primarily because its CYA. "Here's the screen print from Medicare.gov that you got in October. I can't control that the cost of the med went up in April. Have a lovely day!" And that happens 2-3 times a year, max. More likely, I hear about it in October, but with a comment of "it really sucks that we make these decisions in October and you don't know what's going to happen next year."

Whatever. Its just a save to PDF screen print. Takes 30 seconds.

 

[somarco]

I recently stopped sending "illustrations," etc., from Medicare dot gov

I hear you but personally, I do it as a defensive move. When clients complain next year I show them the dot gov report (sent earlier BEFORE enrolling them) as a reminder that it was Medicare, not me, that screwed up.

 

[kgmom219]

I hear you but personally, I do it as a defensive move. When clients complain next year I show them the dot gov report (sent earlier BEFORE enrolling them) as a reminder that it was Medicare, not me, that screwed up.

Great minds.....

 

[somarco]

Great minds.....

 

[kgmom219]

This is how I look after slogging though drug lists and spreadsheets for the last 15 hours......

 

[sshafran]

I hear you, but I


I hear you, but I still send it. Primarily because its CYA. "Here's the screen print from Medicare.gov that you got in October. I can't control that the cost of the med went up in April. Have a lovely day!" And that happens 2-3 times a year, max. More likely, I hear about it in October, but with a comment of "it really sucks that we make these decisions in October and you don't know what's going to happen next year."

Whatever. Its just a save to PDF screen print. Takes 30 seconds.

Understood, but that isn't entirely different than what I can say.

"Yes, I sent you the Summary of Benefits and it's 17% for your Tier 3. If you paid $170, then that Rx must sell for $1,000 at Walgreens. Greedy pharmaceutical industry..."

I'm not trying to avoid the 30 seconds to save the pdf and send.

I'm avoiding Carrier X estimating way too low for the "Full Cost" column of the Rx list, as in the case in point above from this morning. It seems all too common. Celoxicib last year gave me at least 6 angry clients...

Trying to stick to the facts, and what I can control, not the estimates.

I could be wrong, maybe I should rely more on the estimates then blame Medicare when it goes haywire, but I want to roll with the "rely on the summary of benefits" approach for a while and see if it is easier.

It actually isn't that hard to memorize the chart of the top 3-4 plans. Then it's just a game of "which tier?"

 

[Chazm]

I do the same as Shafran and have for several years.
To the OP, don't give them estimates, especially with SS smart Rx. Lots of drugs are Tier 2 and it's not covered until that DED is met. Tell them exactly what the SOB tells you. It'll save a lot of frustration

 

[somarco]

This is how I look after slogging though drug lists and spreadsheets for the last 15 hours......

That's disturbing . . .