Medicare.gov Part D Drug Plan Accuracy?

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destin
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Medicare.gov Part D Drug Plan Accuracy?

Post by destin » Mon Oct 08, 2018 1:59 am

I was using the Medicare Part D comparison site to check on which provider had the lowest annual plan cost. The result was the SilverScript Choice (PDP). This story should have ended there. Except I noticed an issue.

One of the drugs in the SilverScript Choice plan was a Tier III Generic Drug. The plan details says it has a copy of $45. The quote on the SilverScript says $45. Medicare.gov site says it cost about $17. It also says that is the "Full Cost of Drug". The annual calculation was based on $17. I doubled checked the details on medicare.gov and it says it's a Tier III. The Medicare.gov says Tier III has a copay of $45.

GoodRx has a cash price estimate of $70. It has a coupon price of $32.

This is only one drug. There's a few. If Medicare.gov is accurate, I could be saving several hundreds of dollars. If SilverScript quote is accurate, I could spending a lot more then I should. Who is right?

The people on the phone don't have an answer until the plan is used.

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celia
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Re: Medicare.gov Part D Drug Plan Accuracy?

Post by celia » Mon Oct 08, 2018 3:17 am

Could they possibly be saying the same thing? The quarterly price could be $45 while the monthly price is $15 plus a $2 pharmacy fee.

Since Open Enrollment for 2019 doesn't start for another week, maybe they are still entering data into the cost database.

MGator
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Re: Medicare.gov Part D Drug Plan Accuracy?

Post by MGator » Mon Oct 08, 2018 5:08 am

The data has been in the system for weeks already as the website went live last Monday for public consumption - the health plans submitted their data to CMS already. The plan designs have been set for quite sometime as they were part of the 2019 Part D bids from earlier this year (there is a formal process yearly).

OEP begins soon, so best to recheck then and also remember that you can sign up for a plan and have the option this plan year to switch to another plan in early 2019 calendar year if you are unhappy, etc. which is different than last year.

kaneohe
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Re: Medicare.gov Part D Drug Plan Accuracy?

Post by kaneohe » Mon Oct 08, 2018 8:03 am

could you post drug so we can see what you see? Is it possible that one site is looking at 2019 and the other at 2018?

Retired2013
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Re: Medicare.gov Part D Drug Plan Accuracy?

Post by Retired2013 » Mon Oct 08, 2018 8:08 am

I don't know about this year but back in 2017 when I was doing my mothers, I found that by changing the pharmacy and looking at the details, I could get a better deal on one Tier III drug. The deal was better than any of the "Preferred Pharmacies" listed. After I signed her up, I had the doctor send all of her scripts except this one Tier III drug to the "Preferred" pharmacy and the Tier lll drug to the cheaper pharmacy. This saved her hundreds of $$.

3feetpete
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Re: Medicare.gov Part D Drug Plan Accuracy?

Post by 3feetpete » Mon Oct 08, 2018 9:37 am

I had a similar problem with my Cigna part D plan this year. They started off the year by charging me more than what the medicare.gov said the cost would be. One drug they said was a higher tier and another they said they didn't cover the dosage that my prescription required. I paid the higher rate but contested it by sending them a copy of the results sheet from the medicare part D comparison sheet. It clearly showed that I had correctly identified the prescriptions and the dosages. Cigna honored the comparison sheet rates and issued a refund. I assume that means they are losing money on me this year. I'm curious what the comaprison sheet will show this year.

destin
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Re: Medicare.gov Part D Drug Plan Accuracy?

Post by destin » Tue Oct 09, 2018 12:03 pm

Retired2013 wrote:
Mon Oct 08, 2018 8:08 am
I don't know about this year but back in 2017 when I was doing my mothers, I found that by changing the pharmacy and looking at the details, I could get a better deal on one Tier III drug. The deal was better than any of the "Preferred Pharmacies" listed. After I signed her up, I had the doctor send all of her scripts except this one Tier III drug to the "Preferred" pharmacy and the Tier lll drug to the cheaper pharmacy. This saved her hundreds of $$.
3feetpete wrote:
Mon Oct 08, 2018 9:37 am
I had a similar problem with my Cigna part D plan this year. They started off the year by charging me more than what the medicare.gov said the cost would be. One drug they said was a higher tier and another they said they didn't cover the dosage that my prescription required. I paid the higher rate but contested it by sending them a copy of the results sheet from the medicare part D comparison sheet. It clearly showed that I had correctly identified the prescriptions and the dosages. Cigna honored the comparison sheet rates and issued a refund. I assume that means they are losing money on me this year. I'm curious what the comaprison sheet will show this year.
Is Medicare.gov site is more accurate then SilverScript site? I can pick different pharmacies from the Medicare.gov site and the prices change. How does pharmacy and plans work? The "Full Cost of Drug" changes when I change plans even when looking at the same pharmacy.
MGator wrote:
Mon Oct 08, 2018 5:08 am
The data has been in the system for weeks already as the website went live last Monday for public consumption - the health plans submitted their data to CMS already. The plan designs have been set for quite sometime as they were part of the 2019 Part D bids from earlier this year (there is a formal process yearly).

OEP begins soon, so best to recheck then and also remember that you can sign up for a plan and have the option this plan year to switch to another plan in early 2019 calendar year if you are unhappy, etc. which is different than last year.
Is drug prices a regulated process?
kaneohe wrote:
Mon Oct 08, 2018 8:03 am
could you post drug so we can see what you see? Is it possible that one site is looking at 2019 and the other at 2018?
The difference is minor. If you could check, one of the drug is Diltiazem ER Capsule. I was surprised SilverScript, Express Scripts, etc listed it as a Tier III even though it's a fairly common generic drug.

The copy is also different in Medicare.gov, not only for SilverScript but ExpressScripts and other companies in the comparison site. The drug price is always lower then the Tier III copay of the Plan D Provider.

dilligaf401
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Re: Medicare.gov Part D Drug Plan Accuracy?

Post by dilligaf401 » Tue Oct 09, 2018 2:42 pm

I priced this up on both SSI.com and PlanFinder and was able to confirm that both sites matched exactly.

A few things to bear in mind. Make sure you're comparing exactly the same drug (dosage form, strength etc.). SSI.com seems to have many more options of Diltiazem vs. PlanFinder. I selected Diltiazem Hcl Er CAP 360MG/24HR on PF and diltiazem hcl extended release beads 360mg capsule sr 24hr on SSI.com. Also make sure you're selecting the same quantities, # of refills etc.

Finally, make sure you are comparing the full monthly costs on both tools (i.e. premium + member share of drug cost).
I get a $28 premium (I was using a Florida zip as I wasn't sure what region you were in) and a $18.14 for the monthly member share.
So the sites seem to tie to me.
If you're still seeing something different please post exactly what you're looking at on both sites.

cashmoney
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Re: Medicare.gov Part D Drug Plan Accuracy?

Post by cashmoney » Tue Oct 09, 2018 7:05 pm

destin wrote:
Mon Oct 08, 2018 1:59 am
I was using the Medicare Part D comparison site to check on which provider had the lowest annual plan cost. The result was the SilverScript Choice (PDP). This story should have ended there. Except I noticed an issue.

One of the drugs in the SilverScript Choice plan was a Tier III Generic Drug. The plan details says it has a copy of $45. The quote on the SilverScript says $45. Medicare.gov site says it cost about $17. It also says that is the "Full Cost of Drug". The annual calculation was based on $17. I doubled checked the details on medicare.gov and it says it's a Tier III. The Medicare.gov says Tier III has a copay of $45.

GoodRx has a cash price estimate of $70. It has a coupon price of $32.

This is only one drug. There's a few. If Medicare.gov is accurate, I could be saving several hundreds of dollars. If SilverScript quote is accurate, I could spending a lot more then I should. Who is right?

The people on the phone don't have an answer until the plan is used.


Always check your math on the carriers website because there is always going to be data validity issues on medicare.gov.There is a disclaimer on there that says they are not responsible for wrong data.With that said medicare.gov is still a very useful place to start.Always check www.goodrx.com prices to see if there is a worthwhile savings using them instead of part D for some of your drugs then exclude those from your medicare.gov search list to find the most cost efficient plan .

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celia
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Re: Medicare.gov Part D Drug Plan Accuracy?

Post by celia » Wed Oct 10, 2018 4:40 pm

destin wrote:
Tue Oct 09, 2018 12:03 pm
I can pick different pharmacies from the Medicare.gov site and the prices change.
Yes, the pharmacy you select will make the prices change. Costco and WalMart usually have the best price, I've been told, probably because they have lots of volume. But comparing several pharmacies near you is a good idea.
The "Full Cost of Drug" changes when I change plans even when looking at the same pharmacy.
I believe the "Full Cost of Drug" is the agreed-on price between each drug manufacturer and insurance carrier. So, yes, the amount will change when you look at a different carrier. But I do know that the "Full Cost of Drug" IS NOT the price someone without insurance would pay. (That's what I thought for a while until I found out I was wrong.) It's also strange how the "Full Cost" would change during the year (sometimes multiple times). I would think both parties would want a stable price for the whole year when they make an agreement. But what do I know?

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celia
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Too Many Variables!!! (Medicare Part D)

Post by celia » Wed Oct 10, 2018 4:50 pm

Retired2013 wrote:
Mon Oct 08, 2018 8:08 am
I don't know about this year but back in 2017 when I was doing my mothers, I found that by changing the pharmacy and looking at the details, I could get a better deal on one Tier III drug. The deal was better than any of the "Preferred Pharmacies" listed. After I signed her up, I had the doctor send all of her scripts except this one Tier III drug to the "Preferred" pharmacy and the Tier lll drug to the cheaper pharmacy. This saved her hundreds of $$.
cashmoney wrote:
Tue Oct 09, 2018 7:05 pm
Always check your math on the carriers website because there is always going to be data validity issues on medicare.gov. There is a disclaimer on there that says they are not responsible for wrong data. With that said medicare.gov is still a very useful place to start. Always check www.goodrx.com prices to see if there is a worthwhile savings using them instead of part D for some of your drugs then exclude those from your medicare.gov search list to find the most cost efficient plan .
Great. More things to check! :(

I also know the the order you submit your meds can have an impact on the total cost for the year. Of course, this depends on if you take a lot of meds and they are in a range of tiers and if you go through all 4 phases ("in" and "out" of the donut hole). The order would be different for everyone since the specific meds you take (and how many) are different. (To control the order, we let the doctors submit the prescriptions to the pharmacy, but then call the pharmacy to not fill it yet, unless the meds need to be taken that day.)

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