Medicare Part D

Did you look at AARP on line?
Did you look at AARP on line? You can check their formulary, find answers to many questions . . . AND enroll! Here's their URL:

http://www.aarpmedicarerx.com/?PPC=1

Good luck! [/color]

My husband and I are covered by a private prescription plan and did not sign on to Medicare D.

All the same, our long-distance pharmacy is swamped with Rx snafus; medicines that we got without fanfare in the past now require prior authorization and the pharmacists are definitely harried.

How is Medicare D working for you?

I just filled in a couple of prescriptions, and there was a slight problem....................Apparently, even though I had given the pharmacy my new number for the Part D, they had charged it on my old plan, naturally it bounced, and had to charge it again!

Medicare Part D
Well, Noddy, so far we've been lucky.

BUT: We have a private plan that will cover the doughnut hole, but the company has given us a different set of ID numbers. They say that UnitedHealth Care will send us a "Summary of Benefits" and to plug in those numbers instead of the ones UHC assigned. And they say that the pharmacy must keep both sets of numbers in their computer, that that's the law. I sure don't look forward to telling the pharmacy what is and isn't the law.

UHC says they don't have any such thing as a "Summary of Benefits". So eventually we're going to wind up with a mess.


Thank you George W!

Medicare Part D
One very irritating thing about AARP is that although they have a quite extensive formulary, it doesn't list maximum number of doses/pills for each drug. (Perhaps this is true of other formularies). So you don't know until a prescription comes back only partially filled, what the limitation is. And of course, that adds to the nervous strain.

Our doctor wrote a prescription for 30 migraine pills; the official maximum is 18, but no one knew - all the formulary said was that quantities were limited.
So UHC faxed him, he faxed them back, they denied coverage, I had to write a detailed letter appealing the denial, and now I'm waiting for an answer.

UGGH

P.S. And the AARP formulary has mistakes. I ran into one where the drug was listed as 1st tier (generic) and it turned out that not only it wasn't generic, there IS no generic; there is a generic of a similar (and similar name sounding) drug that I hope will work.

My mother has the AARP plan, and she immediately ran into problems because of dispensing limits on one of her medications.

My mother's prescription is for Atacand 16 mg twice a day. That should equate to 60 pills a month, but United Health Care (AARP's endorsed plan) will only fill this for 30 pills a month.

They allegedly denied filling the prescription for the full amount, because they wanted to know whether her doctor had first tried other anti-hypertensive medications which were on tier 1 and tier 2 of their formulary (Atacand is a tier 3 medication). Of course, this has absolutely nothing to do with whether the prescription should be filled for 30 or 60 pills per month. If they approve 30 16mg tablets of Atacand a month, why would they refuse to fill it for 60 tablets a month, as her doctor prescribed it?

The doctor did send info indicating that at least 4 other tier 2 medications had been tried, and all had adverse effects. That wasn't enough info for United Health Care, because the doctor had not indicated whether or not he had read some federal pamphlet, so they, again, denied the request to fill the prescription for the full amount. They also sent the doctor a power of attorney form to be filled out by my mother, so he could appeal the denial. That made no sense at all.

I finally obtained the direct phone number of the pharmacy authorization department (which saved hours of phone waiting time), and the person I spoke to said the situation was finally resolved, but to wait a few days before filling the prescription. Well, my mother waited a week, and when she tried to refill the Atacand they would still only fill it for 30 pills a month. I called United Health Care back and they now said the pharmacist had to call a still different phone number and request a dosage override (which is different than an authorization for a particular drug ). The pharmacist did this and was able to fill the prescription for the full 60 tablets, but he told my mother that this was a "one time only" thing, and they would not continue to do that.

At this point I am fully disgusted. After almost two months the situation has not been resolved, and there is no really logical reason given for why the medication is not covered for the full 60 tablets a month my mother requires. I have already purchased an additional 60 tablets and paid for them out of my pocket so my mother can continue to get the medication she requires. My mother's doctor is fed up with all the time this has taken him to write and fax info to United Health Care, and he doesn't want to waste any more time on it. And my 92 year old mother is so stressed out by all of this she starts shaking when the subject is even mentioned.

I now have to get on the phone, again, with United Health Care to again try to get this resolved. I am out of patience, and quite angry about all of this. If I cannot get this situation sorted out by the end of the week I am considering writing directly to the CEO of AARP to let him know that the AARP endorsed plan is actively interfering with the needed medical care of consumers, by setting up illogical and needless obstacles to obtaining vitally needed medications in the necessary daily amounts.

The illogic of this situation is highlighted by the fact that United Health Care will pay for a prescription for 32mg of Atacand for 30 tablets a month, while they will not pay for 60 16mg tablets a month--although those are clearly equivalents. They, and the pharmacist, both advised my mother to get a prescription for 32mg tablets. Unfortunately, since my mother generally takes 24mg of Atacand a day, that would require her splitting these rather small pills into quarters, something that is not easy to do and still maintain a consistent dose. She can halve the pills fairly evenly, but breaking them into quarters is a different matter, and it's something her doctor really doesn't want her to do.

Nowhere in the info on any of the drug plans do they really spell out what goes on with "dispensing limits"--or why there are monthly limits on the number of pills covered with certain drugs. Is this pure whimsy?
They also do not really make it clear why you cannot obtain more than a one month supply of any medication at a time, unless you order by mail. What difference should it make to an insurer whether you obtain a one month or a three month supply of medication at the local pharmacy? My mother previously had her drugs covered under her AARP/United Health Care medigap policy, and she routinely obtained more than one month's worth of medications at the pharmacy, with no problems from her plan.

Does anyone know whether the "dispensing limits" come directly from Medicare, or are they determined by the insurers?

Medicare Part D
I am running into the same situation. I take a migraine medication which AARP will only allow for 18 tablets, regardless of strength. That is, you can get 18 tablets, AND ONLY 18 tablets whether they are 25, 50, or 100mg.

I have tried appealing, sending a detailed history of my migraine treaatment over many years,but was told that because I wasn't on preventive medication they would not approve 30 tablets per month. I appealed the appeal, and was denied again, this time the reason given was that my doctor wasn't prescribing alternative medication to treat the migraines when they occur. I am trying to decide whether to bother with a third appeal, or wait till the middle of this month when my doctor will be able to prescribe the 100mg which I will cut in half. *Unfortunately, the formulation of the tablets was changed a couple of years ago, and now they tend to crumble when cut...)

I would be glad if they would at least be consistent in their reason for denying the appeal. This is a fantastic runaround - first denied because not prevented, then denied because not treated.

Both times the doctor has sent information, and I have sent detailed histories - why I can't take the usual preventive medications, and what previously tests, etc have been done. The people at AARP/UHC just don't seem to read what we send. The history is very plainly spelled out.

I am disgusted.

Medicare Part D
Am I the only one who has didn't know that the Donut Hole is reached not when you personally have paid $2250 out of your own pocket, but when that amount is added to the amount that the insurer has paid? So it's coming faster than one thinks. A social worker to whom I talked told me that she just found out about this 10 days ago.

Ain't we got fun!

Medicare Part D
A useful phone number for those on AARP/UHC is 1-888 492-2971. This is the number for their pharmacists.

Firefly - is this the number you tried?

Yes, Tomkitten, that's the number I've been calling. But I've gotten conflicting answers from the people I've spoken to, and each time the denial is appealed they come up with a different reason for denying it again. It certainly is a runaround. And I'm fed up with it.

If it is Medicare who is imposing these "dispensing limits" then the situation is hopeless. If it's something the insurance companies are doing on their own, then I'll help my mother try to find a less restrictive plan.

I must check out the information on the "gap" or donut hole".

,

Medicare Part D
Firefly - and anyone else who's interested - I asked AARP about the Donut Hole threshhold yesterday, and got the same answer that the social worker gave me.

Don't you just love the big insurance companies?

Medicare Part D
We are very lucky, with private insurance covering the gap - which will come quite soon, as some of our stuff is basically pretty expensive.

The social worker with whom I spoke (very knowledgeable about Medicare) is recommending Humana's Complete plan (contract ID: S5884; Plan ID: 031) because it covers both brand name and generic drugs during the Hole. There are a few other plans that cover generics, but most just leave the Hole gaping, waiting for you to fall in.

Of course, the information I'm passing along here relates to Massachusetts; we have 45 plans to choose from, people are going nuts.

And very likely you will run into the same stone walls, or maybe others, with your mother's prescription. I always had trouble with Merck concerning my migraine medication, though eventually I got the authorization every time, but Lord what a hassle! One problem seems to be that no one has the final answer; pass the buck, pass the buck is what it's all about.

Yeah, I knew about the way that the donut hole works in Part D. I also have AARP Medigap, which gives you a discount pharmacy card. I was told only to use the discount card where the Part D medication is not covered at all.
If you try to save money in the "donut hole" it will take you longer to get out of that hole and into where AARP will pay 95%.

It is not Medicare that determines whether they will give you a certain expensive drug. It is the individual private providers, like AARP. In other words, they want you to try cheaper medications, before they will approve more expensive ones. If you are allergic to the cheaper ones, or if they don't work for you, they will, grudgingly permit a more expensive medication. Thst is what they mean by "step therapy".

Medicare is making some determinations about which drugs will be allowed under any available plan

Webpage Title

The quantity dispensing limits on certain drugs is what I really don't understand, and that's where my mother is having the problem and Tomkitten is having a problem as well. They will cover the drug, but they limit the number of tablets per month, in a way that appears to be completely arbitrary.
In my mother's case it involves a drug she must take on a daily basis and they are limiting the amount to half of what she requires per month. And they offer no rational basis for the decision to limit the quantity to a certain amount per month.
In addition, as Tomkitten mentioned, they will cover the same drug in a higher dosage. This forces people to get medications in a higher than necessary dosage and then cut pills into halves or quarters in order to get the amounts they require per month. That seems just crazy, and it defies common sense. It results in great difficulty maintaining a consistent dose of medication (pills don't split evenly, particularly into quarters, they crumble, etc.), and it forces older people to fiddle with pill splitters and attempt to pick up tiny fractions of tablets, which not everyone over 65 is even physically capable of doing.

The appeals process is absurd. They are not giving consistent responses for their denials, so it becomes impossible to actually satisfy their demands. If you satisfy one of their conditions, they then come up with another reason for denial. It is an infuriating process to deal with.

Phoenix32890, the pharmacist automatically deducts the AARP discount from my mother's prescriptions, in addition to what the drug plan allows. Since I'm paying for some of her medications out of pocket (to get her the amount she requires), there doesn't seem to be much point in not taking that discount, and she might as well use it too. Also I think those AARP discount cards will all expire in a few months, possibly before the gap is even reached. I think it is probably better to use the discount now than wait until later.

firefly- I am a bit confused. Last year, I had gotten my mother one of those interim drug benefit cards. When I renewed my own Medigap coverage with AARP, they sent me another drug discount card. I did not pay for it, as one did for the interim cards. It came as a benefit with the Medigap. I really have to find out whether the card that I got expires.

As far as my mom is concerned, there is no doubt that she will go beyond the donut. She takes a boatload of meds.

Never letting grass grow under my feet, I phoned AARP. The blue and red card, the one that says "AARP Health Care Options Pharmacy Services", does not expire. It may be used if there is a drug that is not on the formulary, of if you want to use it during the donut!

Medicare Part D
Firefly - Does your mother use one of those little pill-cutters that are available at drugstores? They do help in centering the pill, though not always.
But they can prevent some of the crumbling or uneven pieces.

Yes, she does use one of the pill splitters, Tomkitten. She can cut her 16mg Atacand tablets into fairly even halves most of the time. But splitting each half into even sized quarters just doesn't work well at all, and that's what she'll have to do if forced to use the 32mg Atacand tablets. The 16 and 32mg tablets are about the same size (they are small pills to begin with) and my mother tried quartering a few 16mg tablets to see how well that would work, and it didn't work well at all. Too much of the pill crumbled and the pieces were too uneven in size. And they were so tiny my mother really had difficulty picking them up.

So, I'm going to try fighting a little longer to see if I can get United Health Care to give her the necessary quantity of 16mg pills a month. At the very least I'd like a reasonable explanation of why they will cover one 32mg pill a day, but not two 16mg tablets a day. It just doesn't make sense to me.

Phoenix, my mom has the same pharmacy discount card you do, it also came with her AARP Medigap policy. But she's currently using it, along with the Medicare D coverage.

I think my mother would be better off with Humana's complete plan, the one that does cover some of the gap. It was actually her first choice, but she then impulsively decided to go with the plan AARP endorsed because she trusts AARP. The Humana premiums are almost twice the cost of the AARP premiums, but, over the course of a year, my mother would have saved at least $500 more with the Humana plan (than she will with United) because of the gap coverage. She'd probably have the same nonsense with "dispensing/quantity limits" with Humana, but at least she'd be saving more money.

Firefly - your mother trusts AARP. I've come to the point where I trust them alright - to be obstructive. But you're right, I expect you'd get the same runaround anywhere. The financial saving looks substantial with Humana, however.

A further problem just occurred to me - what about medications that come in capsules? You can't cut those in half! What a mess it all is!

Do you think Homeland Security or maybe FEMA were the real designers of this cockamamie plan?