Now this is a column I really am going to enjoy sharing with you. I think everyone enjoys saving some money, especially in this economy if they can. This is an annual opportunity to review your Medicare Part D prescription drug coverage and ensure you will be in the most suitable plan for next year.
Remember the Annual Enrollment Period runs from Oct. 15-Dec. 7. Medicare changed the dates to ensure that folks would be enrolled and have their new ID cards prior to the start of the plan year on Jan. 1. Previously, people might have had to wait close to a month to receive all their paperwork. From the pharmacies’ and insurance companies’ point of view it was a horrendous task trying to reprocess all those claims from early January that were processed under the prior year’s coverage.
I will share with you three ways in which you can help yourself save some money, and combined, these savings frequently add up to hundreds of dollars per person each and every year.
You shouldn’t just sit back and assume that the plan you were on this year will automatically be the best plan for you next year. Plans do change from year to year, as far as premiums, preferred pharmacies and the formularies or list of covered medications.
You will have received your big fat package from your current insurance company and it is called your Annual Notice Of Change (ANOC) package. Yes, we have made more than a few jokes about ANOC, ANOC … who’s there.
At the very least you should review this material to ensure you are aware what your premiums and deductibles will be for the following year and that all your medications will be covered. For example, if a brand name drug becomes available as a generic, many plans will only cover the generic. Lipitor is an example that I shall mention later on, so if you take Lipitor, please be sure to read the rest of this article and share this information with your friends and neighbors; they will be glad you did.
Another item to check is what I call Tier creep. This is where a drug that was in the Tier with the lowest co-pay has mysteriously moved up either one or two Tiers thus causing you to pay a far higher co-pay.
It seems that this year more than others it is important to ensure that you are purchasing your medications at a preferred pharmacy. All plans say they have more than 60,000 participating pharmacies and every pharmacy in Sequim is participating in every plan.
However, there can be a whole world of difference in pricing between a participating pharmacy and a preferred pharmacy. Here are just a couple of examples.
The Humana Walmart Part D ($18.50 per month, $325 deductible) plan gives preferential pricing if drugs are purchased at Walmart, whereas the new AARP Saver Plan ($15 per month, $325 deductible) has additional savings if you use Walgreens, Safeway or QFC.
Both the First Health Part D Value Plus and the Silverscript Choice plan offer plans that are $28.80 and $29.10, respectively, and have a $0 deductible but they both offer many generic drugs for a $0 co-pay at PREFERRED pharmacies. The First Health plan includes Walgreens, Walmart and QFC as among the preferred pharmacies and Silverscript only has Walmart as the sole preferred pharmacy on the peninsula.
I would most strongly like to point out that all plans are accepted at all Sequim pharmacies — it is just that certain stores have negotiated steeper discounts with certain Medicare Part D insurance companies.
Please take time to review your ANOC notice to find out which if any pharmacies in the area are considered preferred for your specific plan.
Earlier on I had mentioned the brand name cholesterol medication Lipitor. Many folks are aware that in the past 12 months Lipitor became available as a generic under the name Atorvastatin. This year I was amazed to find that not a single Medicare Part D drug plan included Lipitor as a covered medication.
However, the Group Health Prestige MAPD plan does cover it, albeit at a Tier 4 co-pay of 50 percent.
A number of other medications recently have become available as generics and the following is not intended to be a complete listing, but rather a compilation of the more common brand name drugs. The number in parenthesis following the brand name is the number of stand-alone Medicare Part D plans that will cover that medication in 2013:
Lexapro (3, generic Escitalopram), Lipitor (0, Atorvastatin), Seroquel (8, Quetiapine Fumurate), Plavix (4, Clopidogrel).
While very few stand-alone Part D plans cover any of those brand name drugs listed above, I would be remiss if I did not point out that the Group Health Prestige Medicare Advantage Plan does in fact cover all four of those medications. So from a highly unscientific limited review I would have to say that the Group Health formulary is among the most comprehensive in use today.
In addition according to the Walmart website, the following drugs are now available as generics but currently the Medicare.gov website does not show them as available: Singulair, Actos, Detrol and Diovan. If Medicare does approve the generics for use by mid-year, I am unsure which plans will treat current clients who are using the brand name drugs.
I hope these few tips will be of assistance to you and help you feel in control of your Medicare Part D decisions. However, if you would feel more comfortable having assistance in your review, the following resources are available to you.
The wonderful folks of SHIBA can be contacted here in Sequim at 411 W. Washington St., 452-3221, and they hold help sessions twice weekly at the Sequim Senior Activity Center. The Medicare.gov website is a very useful tool that we rely upon daily and if you prefer to call Medicare, it can be reached 24/7 by calling 800-MEDICARE or 800-633-4227. In addition, call your friendly local insurance agents as they should be able to help you navigate this situation.
Phil Castell is an independent insurance agent in Sequim. He can be reached at 683-9284 or
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