UHC PDP going non-commissionable 6/1/25

Their high cost so called "enhanced" plan pays for most of the Rx cost for the expensive drugs, so the client may have those 2 Rx and pay, say $600 out of pocket, still be considered to have hit the catastrophic level ($2000) and about $95 or so a month for PDP premium. I don't get the behind the scenes "enhancement", but 2-3 of the higher cost plans this year saved clients not a huge amount but a few hundred dollars over the lower cost PDP's + OOP, due to the out of pocket being so much higher on the lower cost PDP's. Maybe after doing AHIP this week I will have more insight about how the sausage is made with enhanced drug plans. I know it's somehow the insurer is absorbing cost that counts towards MOOP, but that's what I know for now. And it's unfortunate that some folks mentioned in this thread didn't get help determining if the higher cost PDP's were their smartest option.

They could tell you how the sausage is made, but then they'd have to k*ll you.

I recall reading a piece from one carrier during certification last year and it said the following:

"Agents do not need to know how to calculate the TrOOP, but may want to understand the logic for general awareness"

In another section it says:

"TrOOP calculations will happen in the background. Agents and consumers do not need to know how to calculate the costs but should know that the TrOOP accumulation may differ from what the member pays out of pocket"

In other words, trust us, we got this.
 
Back
Top