Increase by Medicare of drug deductibles

[honeylady]

My husband went to the pharmacy to pick up his Rx for Trellegy for his asthma. The price for a 3 month supply was $703.00. I asked if we could get a one month supply and they said yes for $500. We were totally shocked and didn’t take it. Today I attempted to get a Rx filled for Repatha for my high blood lipids. $706.00 for a 3 month supply. Tried to get for one month and was told that will be $500. I spent about 35 minutes on the phone and s/w 3 different people. I was told that the deductibles were raised. I asked who did that the insurance company or Medicare. Medicare raised the deductible on all of us on Medicare and will not even let us lessen the pain by getting one month at a time. This is the dirty work of Dr. Oz and RFK, Jr. Thanks Trump you disgusting excuse for a human. We cannot afford that kind of outlay so I am going to go without my Repatha. Hopefully I will survive.

[jmbar2]

1. Did you have separate drug coverage?

I'm trying to understand how to best protect myself if I lose my Medicare supplement from the state. I'm on the edge income-wise.

[Norrrm]

2. How can prices be going up so much when Trump said::::

Link to tweet

[questionseverything]

3. If you have part d, you can pay for your covered meds over the course of the year

Medicare prescription payment plan, it’s called

I think the most you can pay is $2100/ year
So your your monthly payment would be lower

[BajaDoll]

4. Same thing happened to me

I had the same thing happen with Trelegy thru Optum home delivery. What actually happened is that Optum WILL split a 90 day R/X into 3 individual deliveries and charge you for one at a time. Instead of $600 + (I FREAKED out!) I was able to pay my deductible and a the cost of only a 30 day supply. My next refill will still be a lot, in fact it is about 56% more than last year. That means I will have to make a 30 day supply last about 45-50 days to make it all doable. I can't speak to how much your deductible went up (mine didn't) but the drug company saw a way to make more profits and blasted us. And there is no generic. Maybe look into Optum if you can. They will also split a full R/X bill into 3 months on a credit card, this helps me a lot.

[honeylady]

5. What really makes me mad

Is that we can’t buy one month at a time. These are life saving drugs for my husband and I. I have to forgo my Repatha as it is unaffordable for us now. I was told that it is Medicare and not the insurance companies making the rules. My husband and I have different insurance companies. I think they just want us to die to save money.

[Ms. Toad]

10. You can buy a month at a time -

the issue is that you have to pay the deductible, no matter how many months you are buying. The maximum deductible is $615 - so you have to pay 100% of the cost up to $615. It sounds like the formulary cost is $500/month (since that is your cost for one month). So for one month, you'd pay $500 (the whole thing, since you haven't paid the deductible yet). For 3 months you'd pay $615 (all of the deductible), plus your share of the remaining $885 (3 months at $500). It sounds like you have around a 10% copay ($88 per prescription) after you cover the deductible. So 3 months would be $615 + $80.

Ask your Part D company about the Medicare Prescription Payment Plan that will at least let you spread the costs out evenly over the entire year.

[Totally Tunsie]

6. Got room in that same boat for me?

I, too, had the same shocking instance when picking up my Trelegy script. Being retired w/o a paycheck, it all comes out of the same retirement savings account anyway, so I bit the bullet and paid the total. At least I won't have to obsess about it for three months running.

Where are those 1000% savings dozing donnie promised us?

[misanthrope]

7. I am on Medicare, Part D with Humana

I just filled a Trelegy prescription last week and the cost was the same as always: $0. Same with the Arnuity prescription I filled. And the Prednisone, azithromycin and cefuroxime after a hospital stay in the last week. I paid $0 out of pocket for all.

[Ms. Toad]

8. You could have purchased a plan with a lower deductible.

It is true that the maximum allowable deductible is higher because of the annual changes Medicare made to allowed deductible and out of pocket cap - but plans are permitted to set lower deductibles and lower out-of-pocket caps if they choose. Generally, it is not worth it because the premiums for plans with low deductibles are so much higher.

Also, if you shop carefully next October-December, when it is time to choose a new plan, you may be able to find one which does not require you to pay a deductible at all for the drugs you need. In most of the plans I've had, only about half of my meds are subject to the deductible.

Finally, as others have pointed out the maximum you can be charged during the entire year is $2100. The Medicare Prescription Payment Plan allows you to spread the costs out over the year, so you don't have to pay a ton of money in the first few months of the year and nothing at the end of the year. (That would let you get your 3 month supply - and whatever other meds you need the first 3 months of the year for around $525 (perhaps less, depending on what the cost of all of your meds over the year is predicted to be))

Check GoodRx for Repatha. I don't know your dose, but the price around her is $239/2 sureclicks - just be aware if you buy it without insurance it does not count toward your annual out-of-pocket. For me, that doesn't matter - my spend is pretty low. But for my spouse it is better to bite the bullet and buy it with insurance, since her spend this year will be over $2100. You probably want to go to Medicare.gov, find your plan, enter (or access) all your meds and see what your annual drug costs are predicted to be before buying drugs off-plan.

(Note: You should have received this explanation back in November-ish from your drug plan, while you still had the opportunity to shop for a better deal. We change plans nearly every year, based on the plan changes. My spouse's plan went from $8/month to $64/month - so we switched to a $0/month plan - she is going to hit the $2100 cap anyway, so no point in paying extra in premiums just to shift when she pays it.)

[Prairie Gates]

9. Elections have consequences