- 4,747
I too am only using Medicare.gov.
I'm also educating clients on Eliquis & Xarelto about the possibility of getting the generics through Canada.
Who to trust on RX comparisons
- Thread starter billyb
- Start date
I too am only using Medicare.gov.
I'm also educating clients on Eliquis & Xarelto about the possibility of getting the generics through Canada.
I'm not trying to sound unreasonable or lazy but three thoughts:
(a) I don't believe the majority of my client's budget monthly, but if I'm wrong it wouldn't change my thoughts on this. I do warn almost everyone "don't forget about the $505 deductible." For those who do budget, who would find a rolling report helpful - I'm sorry - I'm just not doing it (see point "b" below).
(b) I don't believe that it's good for them to base their budget on a faulty report. The numbers have a high probability that they will not be accurate.
(c) I don't want to take my time to do it. I don't know of any other insurance that would work like this w/ monthly estimates.
Medical certainly doesn't:
"In February, we see that you'll likely get a Knee replacement so we're estimating $425 for Feb. Looking over, ah yes, let's see, in June, you have the cardiologist visit scheduled so we've estimated $45 for that. + $125 for X-Rays. Follow up with your PCP in July, so $5 there. Are you planning to get cataracts done in November still? No? Ok, cool. What was that? Oh, no, we don't need to enter the Flu shot in September - that's $0. I think this does it - here's a report."
If we don't w/ Medical why would we with Rx?
I think somewhere, at some point, someone along the lines thought this was a good idea and we all started doing it (myself included) and we all felt like we needed to. I haven't for years. No issues. No rolling reports. I give tier levels and the Summary of Benefits. That's it. And yes, I think it would be helpful for other agents to stop doing the reports and adopt a more simple (and accurate) method.
If they are budgeting off the Medicare.gov reports, then they'll be in for a not-so-nice surprise when Celecoxib goes from $30 to $300 (ahem, 2020).
The donut hole is explicitly explained in the summary of benefits, which I send. I'm not saying we don't talk about it. "Donut hole starts when your Rx's reach $4,660. - a combination of what you've paid + what the ins co paid. I don't know when that'll happen it'll depend on how expensive your Rx's are."
The short form might not fly with your clients -- but I'd recommend trying it. You might be surprised.
Send John Smith with 3 Rx's a summary of benefits and tell him his tiers on his Rx's and you'll be surprised at how few questions you'll get.
Scott, I am sure your system works well with your client base. If it didn't, you would tinker with it until you got it right.
I am the same way, but with a different approach.
Years of experience has taught me that folks don't like to read and they don't like to do math . . . especially percentages. It is not difficult for me to write 1000 to 1500 words (or more) on almost any Medicare topic. I have composed content for web pages, blog posts and emails.
What I found is most folks read the first paragraph and the skim the rest . . . maybe. When I started making videos they attracted more eyeballs and inquiries than anything I had ever tried. The first batch were 10 - 15 minutes. Lately I have found that 1 to 2 minute videos work just as well, if not better.
My explanations, verbal, visual and written are plain language that anyone can understand. Nothing fancy, just effective.
Several agents have asked me to coach them but I decline. I will give them information by email or even talk on the phone for 30 minutes or sometimes longer.
There is one agent on the forum who called me a few years ago, wanting to pick my brain about how I approach the business. I guess I spent an hour on the phone with him . . . he took that information and shaped it into his own approach and has been very successful.
I am not bragging or taking credit for his success, but it opened his eyes about a different way of selling.
Both of us do what works for us . . . until it stops working then we reboot and start over.
During my career, and the last few years in particular, I have talked with a dozen agents or more and almost every time I learned something new and incorporated some of their tidbits into my business model
Nothing I do is unique or invented but I am good at copying things that work for others and make those tools fit my personality and style.
I am the same way, but with a different approach.
Years of experience has taught me that folks don't like to read and they don't like to do math . . . especially percentages. It is not difficult for me to write 1000 to 1500 words (or more) on almost any Medicare topic. I have composed content for web pages, blog posts and emails.
What I found is most folks read the first paragraph and the skim the rest . . . maybe. When I started making videos they attracted more eyeballs and inquiries than anything I had ever tried. The first batch were 10 - 15 minutes. Lately I have found that 1 to 2 minute videos work just as well, if not better.
My explanations, verbal, visual and written are plain language that anyone can understand. Nothing fancy, just effective.
Several agents have asked me to coach them but I decline. I will give them information by email or even talk on the phone for 30 minutes or sometimes longer.
There is one agent on the forum who called me a few years ago, wanting to pick my brain about how I approach the business. I guess I spent an hour on the phone with him . . . he took that information and shaped it into his own approach and has been very successful.
I am not bragging or taking credit for his success, but it opened his eyes about a different way of selling.
Both of us do what works for us . . . until it stops working then we reboot and start over.
During my career, and the last few years in particular, I have talked with a dozen agents or more and almost every time I learned something new and incorporated some of their tidbits into my business model
Nothing I do is unique or invented but I am good at copying things that work for others and make those tools fit my personality and style.
Got a new one for clients that are on the 2.5mg on Xarelto or Eliquis.
"Can I give the daughter advice? I am not a doctor and I can't even play one on a TV commercial, but if you were my mom, I would tell you to ask the doctor if you could get a prescription for the 5mg at 30 (Xarelto) or 60 (Eliquis) for a 30 day supply and cut them in half, so you could save some money"
- 7,450
I am turning into not being a big fan of cutting pills in half.
My doctor wanted me to try Nebivolol at 2.5 mg instead of 5 mg for awhile, so I was splitting an "overstock" of 5 mg pills instead of filling a new script for 2.5. I had pills from India, Turkey and UK.
All the pills were/are scored for splitting. However, the India (and I think the Turkey) ones had a kind of crumbly split, they weren't always even, there was lots of crumble dust and sometimes I had 3-4 pieces instead of 2. It wasn't a big deal for me on this med because I had plenty of pills and seem to have some flexibility on the amount I need to take. However, for an even more expensive med where I had no extras and a more strict need for exact daily dosage, I am not sure I like the idea.
(The UK pills were an exception. They were actually scored twice for cutting into quarters. The scores were deep and the pills also had a coating on them. They split accurately with a snap.).
Arthritic hands make manipulation of small pieces difficult.
2 bottles of same med with different strength can also create confusion if your remembering is not good.
Good thread.
Nice to see so many with plenty of time for a good discussion during this year's enrollment period
While we're at it - that is, the subject of comparing contrasting plans' Rx coverage - any thoughts on what the $2k out-of-pocket cap coming in 2025 will do to Rx plan configuration?
Here's mine: it will change how insurers "do" Rx coverage pretty significantly. exactly how, Im not too sure. feels like MAPD Rx benefit design may look markedly different from standalone design -- I'm just not sure what form the difference(s) will take (big help, aren't I....)
Nice to see so many with plenty of time for a good discussion during this year's enrollment period
While we're at it - that is, the subject of comparing contrasting plans' Rx coverage - any thoughts on what the $2k out-of-pocket cap coming in 2025 will do to Rx plan configuration?
Here's mine: it will change how insurers "do" Rx coverage pretty significantly. exactly how, Im not too sure. feels like MAPD Rx benefit design may look markedly different from standalone design -- I'm just not sure what form the difference(s) will take (big help, aren't I....)
Good thread.
Nice to see so many with plenty of time for a good discussion during this year's enrollment period
While we're at it - that is, the subject of comparing contrasting plans' Rx coverage - any thoughts on what the $2k out-of-pocket cap coming in 2025 will do to Rx plan configuration?
Here's mine: it will change how insurers "do" Rx coverage pretty significantly. exactly how, Im not too sure. feels like MAPD Rx benefit design may look markedly different from standalone design -- I'm just not sure what form the difference(s) will take (big help, aren't I....)
If it actually happens, it'll probably look like this. Part D plans will have higher premiums, deductibles, and copays throughout. This will offset the high claims clients.
MAPD will continue to have better drug coverage than PDPs but they will have to increase copays slightly. Maybe none at all if their reimbursement rate keeps increasing.
Feels like I'm with you on a) larger differences in MAPD vs PDP Rx benefit designs & b) probable emphasis on the main blunt-force implement - deductibles - if steeper-than-currently-experienced maximum deductibles are permitted. I could see some effort to fold the Rx cap into a MAPD plan's maximum deductible, if only in how it's presented (don't ask me how just yet, I haven't really thought it through
But what are you thinking might cause that cap to be revoked? It's one of those "popular with a target audience & not particularly offensive to unaffected people" kind of operational changes....
Feels like I'm with you on a) larger differences in MAPD vs PDP Rx benefit designs & b) probable emphasis on the main blunt-force implement - deductibles - if steeper-than-currently-experienced maximum deductibles are permitted. I could see some effort to fold the Rx cap into a MAPD plan's maximum deductible, if only in how it's presented (don't ask me how just yet, I haven't really thought it through
But what are you thinking might cause that cap to be revoked? It's one of those "popular with a target audience & not particularly offensive to unaffected people" kind of operational changes....
Nearly all the MAPDs I market have NO deductibles, either on the medical side or Part D. But even if they did, I still don't understand how you would "mix" deductibles. What is it you're saying, exactly?
My short reply is "I don't know"
My longer answer is I don't imagine it would be an explicit, formulaic combination - more some kind of actuarial acknowledgment that in '25 the Rx share of plans' spending suddenly jumps up.
Feels like somewhere there's probably some data that suggests what share of beneficiaries currently take a dollar volume of meds that would push them above a $2k cap, which would permit some spitballing on the distribution of the $ we're talking about. I've been too lazy to look but it's probably somewhere associated with the measure that implemented that cap...who knows, the forecast may be much lower than I'm currently imagining....
EDIT: sure enough, the forecast impact is lower than I was imagining. This 8/18/22 Kaiser Family Foundation piece provides some details (about 1/2 way down).
Similar threads
