Riluzole and Medicare Part D

[BlueandGold]

Need some help. I'm going off my wife's BCBS plan in January and moving to 100% Medicare with a Plan F supplement. I have been shopping for a stand alone part d drug plan and every one I've looked at in WV considers Riluzole a "preferred brand" drug and puts in in a tier 4 to 6 with a hefty copay. I thought Riluzole was the Generic for Rilutek? If so, why are the part d plans calling it a preferred brand drug?

Thanks for your help.

Vince

 

[lgelb]

Did you go to the CMS site where you can input your drugs and see how each plan treats them?
Are you looking at 2016 formulary listings?
Sometimes there's a lag in updating but riluzole has been generic for a while. Some expensive generics are penalized, it's true. I did a quick CMS search on your zip/county and got annual mail order cost of $658 for riluzole (if that was your only drug) for the cheapest Part D option. What kind of cost did you see? Did you double check that you can't get a Medicare Advantage plan since if you can those are usually the best deal?

 

[BlueandGold]

I'm sorry Laurie, I didn't realize anyone responded. Thank you. I spoke to the rep at my S.H.I.P. Office and was told I had to shop for a "stand alone drug plan" so that was the criteria I used on the CMS site. I believe 29 showed up and all of them showed a cost share from 32% to 50% with the actual monthly cost ranging from $200 per month all the way up to over $400 per month. And I did look at the 2016 formulary.

The drug plans associated with the Advantage Plans show Riluzole as a generic and some are as low as $2 per month. I was told I'm not eligible for an Advantage Plan.

Brick wall after brick wall....

Vince

 

[lgelb]

That was what I used, also, Vince, a "drug only" (Part D) plan since you said that was what you were doing -- just a cover-the-bases inquiry re MA. But, as I say, I seem to have gotten better results in Part D, so not sure why.

I used your zip/county, riluzole bid, "no extra help," (which would only skew things worse), no other drugs, mail order...I'll send you a screenshot of the top ones.

 

[KimT]

Vince,
I'm in the same boat. I start Medicare and SSDI on February 1. I'm still officially employed at the college and 60 pills were $40. Now, I'll go on a Blue Cross Supplement (which is going to cost nearly $600 a month because of my age....it would be less than $200 if I were 65) and find a drug plan. I take five prescription drugs besides R. and they are all very necessary.

 

[lgelb]

Kim,
I helped Vince find a flat copay plan for drugs -- much cheaper than cost-sharing, generally.

Make sure on the CMS site that you use the dropdown for entering drugs that shows you are using the generic form.

As I think I've mentioned before, my computer screen is showing that you [based on your city] are eligible for a PPO Medicare Advantage or narrow network plan that meets your needs (MA=drugs + supplement, usually better deal]. Did you look at those? Of course, you want a PPO and if I'm remembering right, you had clinics you needed to include.

And all, remember that you don't necessarily want the richest supplement because that can cost more than it's worth. Step 1, try to find a Medicare Advantage plan that you're eligible for. If not, look across all the supplement levels to find the best benefit/premium mix, entering your drugs just as you use them into the Plan D drug list on the CMS site. And always specify mail order 90 day supply, which can be cheaper.

 

[KimT]

Laurie,
I looked at MA and went to Florida Blue's office and talked with an agent. We compared it with the Supplement. The MA had so many co-pays and some of my providers were considered out of network. The out-of-network max out of pocket was $10,000. The in network out of pocket max was $6,700. I'm afraid that, if I go back to Mayo, the Advantage will consider their charges "unreasonable" as one insurance company the college had did in the past. The Florida Blue Supplement premium is around $600 but it looks like Plans F and G will pay for Part B excess at 100%. The MA premium is only $39.90 a month. I guess I just don't trust the out-of-network maximum of $10,000. Shands is in network but that could change.

 

[lgelb]

Oh, sorry, I remember now, Mayo is non-participating in Part B. That's unusual and that's your problem. I'd make sure the supplement clearly states that they will reimburse in full even for nonparticipating Part B providers as some will only pay the coinsurance part up to what Medicare Part B rates would be.

If you weren't using Mayo, likely a MA PPO like FL Blue would be the better deal, assuming you could find good providers in network. Remember, you're only signing on for a year at a time so if the network changes, you can, too.

 

[KimT]

Laurie,
Thank you so very much for taking time to respond to me. I'm not used to such kindness from people I just met. My thoughts were going with the Supplement since I'm still considering Mayo's ALS Clinic, then re-evaluating next year. If I understand correctly, I can switch from the supplement back to an advantage plan? Also, I have a good stockpile of all my meds (I have to buy one from Canada) so the Part D for this year doesn't scare me.