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I’ll play devils advocate here...isn’t this going to create a new problem with people forever stuck in the coverage gap? If their copay goes from 30 bucks to 300 during the coverage gap and the pharmacist tells them not to use insurance because it’s only $250, then they never register the costs and never hit the out of pocket threshold .
The issue is more for U65, either Indy or Group, not Part D enrollees.
I’ll play devils advocate here...isn’t this going to create a new problem with people forever stuck in the coverage gap? If their copay goes from 30 bucks to 300 during the coverage gap and the pharmacist tells them not to use insurance because it’s only $250, then they never register the costs and never hit the out of pocket threshold .
It has been to my understanding that when the pharmacist inputs your info to get that drug it automatically ties you to Part D. So not much of a way to hide it just by going to another pharmacy.
If it was advantageous to make a cash purchase, rather than an insurance purchase, when the insurance copay for the drug was $30, it will continue to be advantageous to make the cash purchase when the insurance copay is $300.
I wonder how many drugs are filled and billed to the PDP but never picked up and never had charges reversed with the carrier.
I do encourage them to call their drug plan and me whenever they get a new Rx but no one ever does that.
Believe it or not, most of them. Not timely, but they do get reversed eventually, because of inventory.
This years classic call. "This new eye drop is killing me. Its $100 a month. I need to switch from Silver Script"
Told her that didn't sound right. Its a $20 RX at CVS.
Client: "I go to Walgreens"
Daughter (who is on the call):" MOTHER. Jenny told you to take all new prescriptions to CVS, in case they are expensive."
Client: "Its a pain to go across the street"
Daughter:" Then pay the extra $80 because you are lazy, but its not Jenny's fault"
You need a better agent
Its based on the whole year and if you are or are not going to hit the donut hole (and get out of it).
Drug costs $500 under Part D.
Cash Price is $400.
Assuming other drugs, you are going to hit the donut hole May-ish. And be out by October-ish and paying 5%.
Or you can pay $4800 for 12 months and never get to the 5% level.
There are WAY too many factors.
1. Total cost of all meds
2. Donut Hole
3. Time of RX
Which is why everyone needs an annual Part D review