Plan D no monthly payment too good to be true?

[cigafred]

I posted this on APC, 36 replies so far, but I am still not clear about this "specialty pharmacies" and the medicare.gov site for comparing Plan D for 2024. Can I rely on the medicare.gov site or do I need to track down each drug to see what kind of pharmacy supplies? I would think the former, but . . . ?

"Looking at an expected giant drug cost for 2024 for my wife, and running the Medicare compare site it seems that the zero cost Wellcare plan has a lower total cost than any other of the 27 plans offered in my area. This seems to be because the catastrophe level is exceeded, and so total cost for Wellcare is lower due to the zero premium. That defies common sense. What am I missing?"

[cesanon]

You have to look at it drug by drug. There are big differences between what drugs each supplemental drug plan covers and doesn't cover.

As a practical matter you have to start with the Medicare e.

[cujoe]

Note: Due to me using a non-dot-gov website for some of the information in my initial reply, I have edited it as appropriate. (It took quite a bit longer to get the revision done than the one day mentioned earlier!)

ciga - A week back, I did sign up for that zero-premium Part D Plan for 2024. However, as long as I stay on my current 3-drug treatment program, it may still be more economical for me to use Scriptco for 2024 - due to paying the plan's "full price" for some drugs during the initial coverage phase. IMO, Part D could not have been made more confusing to consumers if it's "authors" had tried. Every year it is a virtual mine field of varying/increasing deductibles and ever-changing formulary-tier coverages.

As I was not using any scripted drugs when I first went on Medicare (and after looking at the screwy "design" of Part D; i.e., deductible phase, coverage "donut hole", and catastrophic phase), I nixed even signing up for a plan - only to find out (as with Medicare itself, BTW), that by not signing up initially, I would be assessed a charge in every year thereafter as penalty for not doing so. (You can pay me now - or you can pay me later - and, BTW, for the rest of your life.)

With that surprise realization, I now try to find a Part D Plan that has the three drugs I currently use, bicalutamide, dutasteride, and tamoxifen, as generic drugs covered under the plan and in a tier that is "outside" of the the initial phase deductible, which varies up to a max for 2024 of $ 545. The zero premium plan excludes their formulary tier 1 & 2 drugs from the initial phase deductible lists. However, dutasteride is listed as a Tier 3 drug while finasteride is tier 2, so when I need to renew my script for an 5-ARi, I can switch over to that - or use ScriptCo as I did in 2023. Total yearly cost for continuous use at my current dosages ends up being about the same for both, even with the D-to-F 5-ARi switch.

Last year I used what I call a Part D "place holder" that would keep me from adding a second "penalty premium" for not having a plan for that year. (At worse, the $0 Wellcare Plan will do the same for 2024.) For scripts that were outside of their "covered" Tier 1 formulary, I used a one-quarter subscription to ScriptCo ($50 quarterly subscription) and got 90-day scripts filled for all three drugs @ ~ $30 with free shipping (one per quarter). So total cost was $50 + ~$30 = ~ $80 for 90-day supplies for all three.

In some previous years, I have also used GoodRX's on-line coupons for reduced pricing at various local pharmacies. If you are taking abiraterone, both ScriptCo and Mark Cuban's have similar reduced pricing for that in a generic form. (Note that only drugs that are off-patent and have generic alternatives are available via on-line pharma outlets like these.)

ScriptCo' current price for a 120 tab Abi script is $80.22 + $50 quarterly fee = $130.22 (with one free shipping per calendar quarter)

Cuban's CostPlusDrugs current pricing for 90 tabs Abi (the max shown) is $90.50 + shipping and taxes.

Note that Cuban's site shows the manufacturing cost of Abi @ $73.80. A far cry from the $3279.60 list price for a 90-day script for the drug.

The official US.gov site for Medicare still has the feature allowing the comparison of total cost for Part D Plans - by putting in your scripted drugs and expected dosages to compare total yearly cost; i.e. drugs + premiums. The complication of varying insurance plan drug formularies (same drug can be on different tiers for otherwise similar plans) and different deductible portions, esp. in the initial phase of coverage is apparently taken into account by the plan comparison feature. Just be aware that the information on drug pricing can change during the year, so reflect only the 1st quarter of 2024.

IMO, it is a 100% disgrace that the clown-crew in DC would create a plan so difficult to negotiate and with such major year-to-year changes. As a result, the American public has to basically start from scratch every year to evaluate the best plan. The Part D drug-benefit plan is a shinning example of the USA having the very best government that special interest money can buy. (And Big Pharma is literally taking THAT to the bank.)

As j-o-h-n like to say, "Good Luck and Good Health" to you.

Keep Staying Safe & Well,

Ciao - K9 terror

[cigafred in reply to cujoe]

I have had a fine, including liquid, dinner, so will focus on this tomorrow, but in the meantime--I have been getting dutasteride from All-Day Chemist for years, cheap and no problem. Many others on APC also have used All-Day. Only customs problem I have had was with Mon Coin Sante and cantabiline.

--I have used the compare-3-plans on Medicare.com several times in the last week. Maybe you voted the wrong way?

BR

[cujoe in reply to cigafred]

I have discovered the reason for the inability to compare total year-end plan costs. I will revise my reply accordingly later today. (BTW, In our current forever-surveilled electronic world, "voted the wrong way" could have well been the right answer.🧐)