WellCare part D

[Jewelrylady]

These are the specialty pharmacies that WellCare used for 2023 and what their using for 2024. Has anyone used the 3 for 2024 for Zytiga (aberaterone)?

Our specialty pharmacies include:

2023 Members, please call:

AcariaHealth Pharmacy: 1-844-538-4661

Accredo Health Group: 1-866-718-7952

Optum Specialty Pharmacy: 1-877-546-5779

CVS Caremark Specialty Pharmacy: 1-800-237-2767

Walgreens Specialty Pharmacy: 1-888-782-8443

2024 Members, please call:

AcariaHealth Pharmacy: 1-855-535-1815

Accredo Health Group: 1-833-750-9975

Walgreens Specialty Pharmacy: 1-888-782-8443

[DrawingSnowmen]

NM I found the link. We're having the same issue with Wellcare Part D for 2024... significantly reduced access to specialty pharmacies. We may have to change to a more expensive plan because of this.

[Lefty26 in reply to DrawingSnowmen]

Having same issue I'm trying to find the best D plan which offers specialty pharmacy with the most comprehensive prostate cancer related drugs. What did you find?

[cigafred]

May I modestly hijack this thread to ask how you know if a specialty pharmacy is required. If I follow the 2024 Medicare drug website and it shows Wellcare covering a certain med, do I still have to worry that that drug may require a specialty pharmacy not on the Wellcare list and therefore not covered?

[Jewelrylady in reply to cigafred]

The Zytiga is an expensive medication and the specialty pharmacies have programs that help pay for the med if you meet certain criteria. I’m not completely sure how it all works, but my husband doesn’t pay anything for his Zytiga because our adjusted gross income meet their criteria (bio plus specialty pharmacy)

[DrawingSnowmen in reply to cigafred]

My understanding is that a specialty pharmacy is required for certain drugs, generally the ones in tier 4 that are very expensive. I know they show those drugs with pricing at regular pharmacies at medicare.gov but I have called a couple of regular pharmacies and was told they don't handle those types of drugs (Orgovyx, Erleada, etc) and you have to go to a specialty pharmacy. I think (but am not 100% sure) that this is required by the FDA. So, you may just want to call your regular pharmacy and tell them what you need and see what they say.

I think if your drugs are in formulary for the plan they'll be covered but you may have to go through one of the specialty pharmacies on their in-network list to get it. Much better to find out now for sure than after the open enrollment deadline.

[cigafred in reply to DrawingSnowmen]

Thank you.

[DrawingSnowmen in reply to cigafred]

For example, here's what it says on the Orgovyx page at goodrx:

>This is a limited distribution drug and is generally not available at a pharmacy.

This drug is only available at select specialty pharmacies, which usually means:

It may be expensive.

You cannot fill this in a regular pharmacy.

This drug has a complex regimen to manage

goodrx.com/orgovyx

[dhccpa in reply to cigafred]

Same question for me about the generic version.

[Lefty26 in reply to cigafred]

Having same issue I'm trying to find the best D plan which offers specialty pharmacy with the most comprehensive prostate cancer related drugs. What did you find?

[DennisDworak]

I’ve recently been having problems refilling my Zytiga prescription. The cost is prohibitivey high at my normal specialty pharmacies. I found a supplier in India where I can get my monthly supply shipped to me for US $170 per month & no prescription needed.. And they have hundreds of US customers with a lot of positive testimonials so that is the route I will be taking I think the company’s name is Medixo .? So check it out

[Jewelrylady in reply to DennisDworak]

Try calling BioPlus Specialty Pharmacy [phone]. They are in the US and my husband was approved in one day and he pays nothing. You do have to meet financial criteria for adjusted gross income.

[GumpaD28 in reply to DennisDworak]

No idea what state you live in but here in Pa when my 1st script came up the price for my Abiraterone Acetate was $9,000/mnth. My insurance brought it to my out of pocket would cost $900/mnth. Who can afford that? The kicker the receptionist at the Specialty Pharmacy hooked me up with PACE. State program from money from the PA Lottery. I pay $8/mnth. So check on your state funded programs especially if a senior citizen.

[Derf4223]

Sometimes I think the specialty of specialty pharms is to extract big $$ from your insurance and your copay is not their problem. Strike sometimes.

I use a generic cash-only US pharmacy scriptco.com and a 3 month supply of Abiraterone runs about $300. Not a typo. There are other US-based cash only generic pharms if by chance you don't like scriptco.com.

[Professorgary in reply to Derf4223]

I use mark Cuban cost plus drugs and a 120 tablet bottle runs $130 to delivered. Then to make the deal sweeter I only take one tablet daily with 350 calorie low fat breakfast. Psa went from almost 20 to 2.6 in two months. My MO is on board with this and extremely pleased with all of my numbers. I also started Xgeva monthly but hope to reduce that to every three months.

[awb1 in reply to Professorgary]

In my experience, many drugs are effective at lower doses. The original trials are at dosing higher than needed (to get it approved), therefore the FDA approval is for the high dosing. The pharms have no incentive to study lower dosing. My favorite example is Xtandi; the poster child of pharm greed coupled with FDA and political "look-the-other-way" -ish-ness, while patients suffer the unnecessary side effects. I take 6 capsules every 5 weeks as part of my self-devised BAT protocol. Enza should be generic anyway.

[robobob7777 in reply to awb1]

It's a tough call, it does seem like "follow the money". Why did the stop low dose Abi after 13 weeks. If everyone cut the cost of drugs by 75% who will pay for their mansions and yachts🤑

[dhccpa]

I didn't realize one had to use a specialty pharmacy. I just joined Wellcare Classic and they give a price for Walgreens, Publix, CVS, etc. I can't simply buy the generic abiraterone acetate at a store?

[DrawingSnowmen in reply to dhccpa]

I think because it's the generic you can get it at a regular pharmacy but call your regular pharmacy and ask. The name brand (Zytiga) is only available at specialty pharmacies according to goodrx but the generic is distributed through regular pharmacies.

goodrx.com/zytiga?label_ove...

[dhccpa in reply to DrawingSnowmen]

OK, that's helpful. Thanks. I'll definitely go with the generic.

[Professorgary in reply to dhccpa]

You don’t need a specialty pharmacy for abiraterone.

[dhccpa in reply to Professorgary]

Excellent! Why would anyone use the brand-name Zytiga?

[DrawingSnowmen in reply to dhccpa]

See the above comments, some people are getting it at no charge. They will have to go through a specialty pharmacy.

[Jewelrylady in reply to dhccpa]

My husband gets the aberaterone from bioplus . I just call it Zytiga

[robobob7777 in reply to dhccpa]

To help support the cost of mansions and yachts🤑

[dhccpa in reply to robobob7777]

Every drugco exec should own at least three of each.

[Bspouse in reply to dhccpa]

I just called a local CVS and they said they dont actually fill the prescription but they send it to a specialty pharmacy who sends it to CVS and then they give it to us. I thought that sounded OK, but now seeing that the Wellcare list of specialty pharmacies has decreased , I am concerned they might not be able to fill the prescription on time. May stick with the plan we had before ( AARP Walgreens) even though it shows as costing $700 more for the year. or maybe try the Mark Cuban or scripto.com online sites..

[dhccpa in reply to Bspouse]

Yes I had AARP Walgreens this year but just switched to Wellcare Classic. I'm not on AA yet but the prices shown on Medicare's pharma plan finder seem reasonable. Hopefully it's accurate.

[Bspouse in reply to dhccpa]

I did some more checking. Our local specialty pharmacy shows as out of network on the Medicare site. But on WellCare website it shows as in network. So will probably switch his to the WellCare. I have had WellCare for 2 years with no problems. For the few meds that came up really high( ex. albuterol inhaler) , I used GoodRX to fill.

[j-o-h-n]

I get my NUBEQA (darolutamide) from CVS Caremark Specialty Pharmacy: 1-800-237-2767

I understand that the whole CVS facility is enclosed in a padlocked thick acrylic shield. The Building manager has the front door key needed for entering and exiting employees.

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/19/2023 5:23 PM EST

[dhccpa in reply to j-o-h-n]

Thanks. I understand the pricing now.

[MyWifeMyLife]

Hi there JewelryLady,

My former husband that passed away back in October of 21’, used Zytiga. One of the many meds he was on. The pharmacy be used was actually Rite aide. The people that worked there were above the curve intelligent And friendly. Yes he was required to pay more & a copay but it was worth every penny!

It was never my intention to confuse anyone on this site, he knew I was the researcher & gave me this name. He just couldn’t handle reading any sad news on this site so he knew my background well and handed it to me.

Don’t forget about Rite Aide in Felton, CA. 🙋‍♀️

[Jewelrylady]

update: we’re having a hell of a time getting his prescription transferred from BioPlus to Alliance which handles Walgreens specialty pharmacy. BioPlus wants to fill Decembers prescription which makes sense since my husband won’t have the new Part D plan until January 1st.

[Lefty26]

Having similar issue I'm trying to find the best part D plan which offers specialty pharmacy with the most comprehensive prostate cancer related drugs. What did you find? Thank you.

[Jewelrylady in reply to Lefty26]

we’ve already signed up for Wellcare for Part D. It’s 40 cents a month! I’m just trusting that after BioPlus fills December order for Abiraterone, we’ll be able to transfer prescription to Alliance🤞🤞🤞

[Lefty26 in reply to Jewelrylady]

Not sure re your using BioPlus according to Medicare, specialty pharmacy for wellcare is Acaria Health. Have you had any problems communicating with Wellcare staff..everytime I call I get someone who speaks really poor english and I can't understand them

[Jewelrylady in reply to Lefty26]

We can’t use Bioplus with WellCare. Alliance manages the specialty drug company for WellCare. Yes, hard to understand when calling WellCare