Supplemental Medicare prescription coverage

[kelly]

Was wondering if anyone has found a supplemental medicare prescription coverage plan that meets the needs of PALS in New York. Just starting to search for this coverage..want to get the best one for my hubby. Thanks, Kelly

 

[rose]

New Jersey here (but I can see NY out my windows ) I could not find a single plan that gave sufficient coverage to afford continuing taking Rilutek. I did not extend my COBRA, and was shocked at how spotty the coverage is with any of the prescription plans I could choose from with Medicare. In the end, after researching so many (and it is confusing) I pretty well said ** it, and picked the cheapest one.

Rilutek aside, look at other prescriptions he takes, for example, to sleep I was taking Ambien CR, but there is no generic for the CR version, so its not covered. I did switch to the regular Ambien, its covered and cheap, but it does not work nearly as well. It may be that some of the plans would have covered it, I just got fed up with trying to make sense of it, and was afraid of finding myself outside of the time window allowable to choose any of them.

good luck!

 

[kelly]

Hi Rose,
Man...this is not an easy system to navigate. Did you decide to discontinute rilutek? My hubby says if it is to expensive he will not take it anymore..that is maddening on so many levels. I mean..not mad at Andrew..but mad at the big picture. I will someday have a voice again..and fight for medical/insurance reform with ALS! Thanks for your great advice.

 

[Kevinski]

hey

Hey kevin here drop me an email remember what i said i can send you the prescriptions love ya

 

[rose]

Kelly,

Yes, I did discontinue it. I'd already started and stopped a couple of times because I was having some problems I thought could have been side effects. I'd just decided to go back on it and stay on it when I found out I couldn't afford to. The only way it could have worked out for me would be if I were covered under someone else's prescription plan. Its the darned "donut hole" or "gap" that gets you. You figure it does not take long to reach the $2,250 of prescription costs when the rilutek alone is $900 a month, if you only take rilutek, that is not even three months before you fall in the gap, and pay all costs until you reach the $3,600 mark ~ But all the while you're still paying premiums too! So, up to the $3,600 you've got premiums, and either most or all of the cost of the rilutek, then whatever amount it is after you reach the other side of the hole. The best estimate I could come up with was it would cost over $7,000 with any plan in premiums and meds a year to stay on it. How can anyone afford $900 a month for just one drug for any months out of a year?

Thinking back on it now, I don't see how it could be that much, but it must have been, it just still amazes me is all. No one could tell me for sure what the precise price was. I even went and talked to my pharmacist, and he said that he only could know what to charge me after it was submitted (and obviously after I'd elected my policy). How can it go from $25 a month on my group insurance prescription plan, to several hundred dollars, and that's the "non donut hole" months ?

It is very hard to put a price tag on how much a possible few months extra is worth. It sounds awful, but its true. If we could know ahead of time how effective it would be for us individually, or how fast our progression will be, it might make it easier, but then again, maybe not.

I did feel that navigating through the choices was harder than it needs to be. I called them on the phone, and who I talked with tried hard to be helpful, but she really couldn't advise me much. Then, too, its hard to know what medications could be added in the future.

I need to refill my migraine script, I have not done so since my insurance changed. With my previous coverages it ran about $55 for only 8 tablets, so I'm just bracing myself for the worst, I just don't want to know! ~ but I don't want to end up with a migraine and nothing to take for it either. I've looked in all the places I've squirreled them away in the past, every zip compartment of every purse I own, any other likely place I might have stashed one, and have resigned myself that I've used them all.

good luck, its a learning experience, that's for sure!

 

[mare]

We just went thru this in April: it IS confusing (now I understand what my 80yr. old parents go thru with medical issues).

Give yourself lots of time to do your homework (if you have the luxury of time!); looking at the entire list of plans is daunting.

In the end, what we found is the price of the Rilutek is basically the same, within $100/yr
in most programs. (the overall price averaging $900- 925/month) It is not a drug that the price is negotiated on, as in some plans different drugs are covered at different rates.

So, it is important to consider ALL other meds and check the coverage on those (as Rose found out with some of hers). You do this by entering all you current meds and it will say what your co-pay is.

e.g.- the only other med my husband has is Clonazepam; on our Blue Cross plan our co-pay was only $4/mo. but with the new plan this is outside the formulary, and it is not covered, but it is not bad @ $18/mo.

What is important (I think) is the amount of your co-pay for all drugs, both before and after the dreaded "donut-hole"; and the amount of the premium payment.

When we looked at the plans online, we first looked at the over-all ratings for customer satisfaction and then the bottom line for annual cost and chose the 2nd least expensive.

If his needs change, we can change plans at the end of the year.

One note of caution: if you are signing up when you first receive medicare, and therefore are eligible to enroll at any time of year (as opposed to the Nov./ Dec. enrollment time), be prepared to allocate a large block of time to dealing with the person at the other end of the phone!

My husband was on the phone for over 2hrs. trying to get the "representative" to let him speak to a supervisor! Even had a conference call with his case worker at SS to explain the situation- very frustrating ! Just be calm, but persistent- do not take no for an answer.

 

[rose]

Mare,

What you pointed out about the varying cost of the Rilutek is something I'd meant to bring up, so I'm glad you did..

When I was covered under ExpressScripts through Aetna, (COBRA), its paperwork listed the cost (to them) as, about $850. I don't remember the precise amount, but it was definitely under $900. ~ and my copay was $25 for a month's supply.

Then ALL of the medicare options listed their cost as being higher than this, like you said, in about a $100 range of each other, and all of them had it listed at $900 and above. To add to the pain the co-pay was much much higher. It honestly seemed rigged against the PALS.

I kept looking at the satisfaction ratings of the plans, trying to balance what the pros and cons were felt to be with how much the premium was, how much the copays would be, and, eventually, like I'd said in my original response, it just became too overwhelming, and I chose the cheapest option. It was too many apples and oranges, so to speak.

If a person has other known medications they need on a regular basis, that would be something important to factor in. I could find NO medicare plan that would pay for the Ambien CR, and as there are periods of time when I take the migraine meds very frequently, but then can skip even whole months between needing it, I took it out of the equation

 

[kelly]

Rose..thanks so much for all the time you put into your note...much appreciated. You really said it all with the frustrations on the cost of rilutek. Kevin...love ya! Mare....also great advice. Will let you know what we decide.
Kelly