- 31,326
Please tell me you don't look like Steve Martin.
Silver Script SmartRX PDP
- Thread starter Slade
- Start date
I think it was one of your posts on this either here or on FB a while back that got me thinking along these lines. Stick to the summary of benefits and Tier levels and don't estimate actual costs [obvious exception being tier 1 @ $0 or $1 copay].
Thinking along other lines of insurance, imagine if we'd estimate/illustrate $625 for a crown when it's 50%. None of us would do that (nor should we).
Please tell me you don't look like Steve Martin.
Well. Not today.
Ask me again on Dec 16....I may have a different answer!
- 31,326
- Thread starter
- #35
Forget about depending on pricing at medicare.gov
How about the SS agent portal? Do you think you should get the accurate negotiated lower retail costs of prescriptions there?
How about aetnamedicare.com for prospective members shopping for a plan? Accurate retail costs there?
Rosuvastatin is just one example, it is across the board.
Rosuvastatin 5mg 30 tablets @ standard retail pharmacy
Quoted prices as of today for 2021 and 2022:
Agent Portal @ enrollmentportals.com
$2.56 full cost
Prospective DIY member @ aetnamedicare.com
$2.56 full cost
Prospective member or agent @ medicare.gov
$2.56 full cost
Current member portal @ caremark.com
January through September 2021
$2.56 full cost
October 2021 $19.00 co-pay $21.00 full cost (720 % increase)
January 2022 $19.00 co-pay $21.00 full cost
A drug plan wants to change the retail cost of a drug from $2.56 to $21.00? Fine, then update all their drug pricing data bases.
How about the SS agent portal? Do you think you should get the accurate negotiated lower retail costs of prescriptions there?
How about aetnamedicare.com for prospective members shopping for a plan? Accurate retail costs there?
Rosuvastatin is just one example, it is across the board.
Rosuvastatin 5mg 30 tablets @ standard retail pharmacy
Quoted prices as of today for 2021 and 2022:
Agent Portal @ enrollmentportals.com
$2.56 full cost
Prospective DIY member @ aetnamedicare.com
$2.56 full cost
Prospective member or agent @ medicare.gov
$2.56 full cost
Current member portal @ caremark.com
January through September 2021
$2.56 full cost
October 2021 $19.00 co-pay $21.00 full cost (720 % increase)
January 2022 $19.00 co-pay $21.00 full cost
A drug plan wants to change the retail cost of a drug from $2.56 to $21.00? Fine, then update all their drug pricing data bases.
I lost my book because I didn't know Aetna had a time limit on certifying for 2021. I completed the training 10 hours after the deadline, December 8th at 11 am. I received an email last week from an AmeriLife rep stating that I had not certified for 2022. I called him and told him that one of his coharts had told me that he could flip a switch and my book could be back in my name in May 2021 and I still hadn't heard a word. He said that he had an agent where the same thing happened and he got this response from Aetna "The agent will be able to receive commissions going forward, but he can not receive past renewals. The client is able to request the agent to be their agent of record again. The client may enroll and also request him after he is is ready to sell. The agent will not receive the initial commissions for this member only renewals going forward." In other words I can't get my 2021 renewals, I estimate about $4100, but if I get the client to request me as AOR then I can get future renewals. If I can't convince them to change to another PDP then I may request an AOR change. Otherwise I am going to do my best to get them away from AmeriLife/Aetna.
The drug plan is not changing the price of the retail cost. Stop estimating retail price and you'll save yourself a lot of headache. Tell the client a tier 2 medication is up to a $19 co-pay after deductible. Leave it at that
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- Thread starter
- #38
These tools are not just for agents, they are available for consumers as well and we are all being misled.
Based on what you are saying, these tools for agents and consumers may as well not even exist. As long as they do, people are going to use them, stars will be lost and sanctions will be imposed, again.
An estimate by definition can be off as much as 20% up or down. When the difference overnight is as much as 1000% across the board, it wasn't because an estimate was off. The plan is no longer performing as designed. Negotiated discounted prices on drugs were taken away and it is not being reflected in the data bases.
Based on what you are saying, these tools for agents and consumers may as well not even exist. As long as they do, people are going to use them, stars will be lost and sanctions will be imposed, again.
An estimate by definition can be off as much as 20% up or down. When the difference overnight is as much as 1000% across the board, it wasn't because an estimate was off. The plan is no longer performing as designed. Negotiated discounted prices on drugs were taken away and it is not being reflected in the data bases.
Jerks.
You need a week in July to get this crapola done. Best advice I got when I added the dark side.
Haven't read all of the posts so I don't know if this has been addressed yet
But with this plan need to check why is it the lowest, If its because all the meds are tier 1 Then ok
However, if its because all the drugs are tier 2 or higher but it just shows lower than realistic retail cost then that's the issue
I also have this issue with plans that have tier 3 and 4 at % copays
You can look at the same med on 1o different plans will have 10 wildly different retail costs showing many times
So unless its a fixed copay there is no confidence on what the cost will be
But with this plan need to check why is it the lowest, If its because all the meds are tier 1 Then ok
However, if its because all the drugs are tier 2 or higher but it just shows lower than realistic retail cost then that's the issue
I also have this issue with plans that have tier 3 and 4 at % copays
You can look at the same med on 1o different plans will have 10 wildly different retail costs showing many times
So unless its a fixed copay there is no confidence on what the cost will be
