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ghstudio

Medicare Part d enrollment - frequent travelers be cautious

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Posted (edited)

We are at open enrollment (medicare) time in the US.  One of the options is to take a separate Medicare D plan which covers drugs.  Sounds good, sounds easy...there is even a government site to help figure out which plan you might pick.....but there is some hidden fine print behind some of the policies that may effect you, if you travel outside the US multiple times during the year as we do.

 

The concern is if you are almost out of pills and need a refill before you go on your cruise/vacation outside the US.  SilverScript only allows you to refill 7-10 days before you run out of pills (they track)....so if you are leaving eight days before,  you need what's called an "emergency override".  Silverscript will allow you to do this once per year per prescription (undocumented as far as I could find).  But that works only if you need to do it once.  We are leaving on a cruise on Wednesday...and the normal refill can't be made until Saturday....so my pharmacy got an emergency override.  That's fine for this trip...but we have several more multi week trips planned and without careful planning, I could wind up needing another early refill within the year (yes...I know at this point, it won't happen this year...but the same situation could easily occur next year).  I called and was told it's a strict policy and they won't do a second early override...I would have to pay for the drugs myself.  I didn't know this...and I doubt that anyone else knows that's the policy....but now you do.  According to my pharmacy, SilverScript is the tightest on refills.  I talked to three different reps because this was new news to me.... and they all confirmed the 1 early refill per prescription per year.

 

If you might have this situation...you might want to check this out....there's more to selecting your insurer than just the price. 

 

We will not be renewing with SilverScript.

Edited by ghstudio

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Posted (edited)

Thank you for the head's-up.  Now that I think about it, I am currently on a non-Medicare health plan, and a pretty good one.  Last year I faced a similar situation that you described and they had to do the emergency override.  I was also told that it is a once a year thing.  Even though I was not getting an early refill for painkillers, just boring thyroid meds.  This was with BCBS/Caremark.  Who comes up with these rules?   No common sense.

 

Good luck with your meds!

Edited by Muushka

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I am currently facing this (again) so called primary care doc who wrote me a new scrip for my med.  Then used Goodrx app for cheapest fill from a local pharmacy without going through my insurance. Got a 90-day supply for $11.34.  Why didn't I do this sooner??

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38 minutes ago, Muushka said:

Thank you for the head's-up.  Now that I think about it, I am currently on a non-Medicare health plan, and a pretty good one.  Last year I faced a similar situation that you described and they had to do the emergency override.  I was also told that it is a once a year thing.  Even though I was not getting an early refill for painkillers, just boring thyroid meds.  This was with BCBS/Caremark.  Who comes up with these rules?   No common sense.

 

Good luck with your meds!

Don't know if you're just on Levothyroxine generic...but you can get a 3-month supply @ Walmart for $10 WITHOUT going thru your insurance.  I have been able to get an early refill more than once on this.

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I have had to use the emergency override also for a trip and was told that it was once a year.  Fortunately at this point all my meds are very inexpensive and we can easily pay for them ourselves. But this is not the case for everyone and could change for myself in the future.  Perhaps a new prescription for a months supply might work. Not sure what the best work around would be for this problem. 

 

Mary Ann

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MD here - this is pretty common now with widespread pharmacy benefits management plans.

Makes no sense to me, but I'm not the kind of MD that writes lots of scrips, so maybe there is something about the policy that I don't understand - I do know that it is NOT just pain meds and not just expensive non-generic meds either. I do think an MD can write you a new scrip or a bridge scrip as someone else mentioned, at least on non-Medicare plans.

If you are a frequent traveler with multiple meds, consult with your pharmacist about options. Medicare rules are so obscure that I wouldn't be surprised to find out that you can't technically do what was mentioned above - I don't KNOW that , but I just wouldn't be surprised.

When the time comes - traditional Medicare for me, with a strong supplement - no Medicare Advantage as long as I can afford the premiums!

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Posted (edited)
32 minutes ago, cangelmd said:

 

When the time comes - traditional Medicare for me, with a strong supplement - no Medicare Advantage as long as I can afford the premiums!

 

Even with Medicare, a good medgap plan and a part D drug plan, there are these gotchas.....in my case the drug I needed was $600+ a month without the plan....and about 1/2 that with the plan (donut hole).  We are switching to what I think is a slightly more flexible plan....we'll just have to go to Walgreens instead of CVS....not a big issue.

 

The medicare part D site is very very confusing.....if anyone uses it, add your monthly payments to the total drug cost shown to get your real total annual estimated cost.   Repeat: Total drug cost is NOT your total cost.  The deductible, however, is in that total drug cost so you don't have to add it again.   

 

 

For those that want to "bank" some of their drugs....at least the expensive ones, When I change plans,  I plan to get a new prescription from my doctor under the new plan and get it in January irrespective of what I have on hand.  That should give me a safety net of some extra medication in case this catch 22 comes up in the future.  

Edited by ghstudio

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Don't forget that the yearly open enrollment period is coming up where you can change your Medicare plans if you want.Here in Massachusetts, most towns have SHINE volunteers at their senior centers who can go over the pros, cons and prices of the different choices (make sure to bring a list of your meds if you're looking at Medicare D plans.) The problem listed above would be a good one to discuss with the SHINE worker to see if some plans don't have this regulation. SHINE appointments are free and well worth doing to make sure you have the best coverage for you since everyone's circumstances are different. Other states may well have the same program or similar, a call to your senior center would tell you what's available where you live. 

 

PS -- SHINE is an acronym for Serving the Health Insurance Needs of the Elderly

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39 minutes ago, ghstudio said:

 

Even with Medicare, a good medgap plan and a part D drug plan, there are these gotchas.....in my case the drug I needed was $600+ a month without the plan....and about 1/2 that with the plan (donut hole).  We are switching to what I think is a slightly more flexible plan....we'll just have to go to Walgreens instead of CVS....not a big issue.

 

The medicare part D site is very very confusing.....if anyone uses it, add your monthly payments to the total drug cost shown to get your real total annual estimated cost.   Repeat: Total drug cost is NOT your total cost.  The deductible, however, is in that total drug cost so you don't have to add it again.   

 

 

For those that want to "bank" some of their drugs....at least the expensive ones, When I change plans,  I plan to get a new prescription from my doctor under the new plan and get it in January irrespective of what I have on hand.  That should give me a safety net of some extra medication in case this catch 22 comes up in the future.  

Even if you switch plans, both plans are still Part D plans.  My wife tried this last year and was told she had to wait between refills.  

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WOW...we are on a Medicare Advantage Plan called "SCAN" and we have never had this situation!! We do need the "vacation override" sometimes but there has never been a limit...guess I need to double check on that! I know many don't like the HMO aspect of the Advantage Plans...but I worked in health care here in SD for many years...and we had HMOs "way back when" so I'm not as adverse to them as soon...and it certainly is less expensive!

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We also have Silverscrpt..We have to plan carefully and stockpile when we can.  Refill  a few days early each time  and  build up a small surplus..get sample eye drops from eye dr too.

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4 hours ago, ghstudio said:

 

For those that want to "bank" some of their drugs....at least the expensive ones, When I change plans,  I plan to get a new prescription from my doctor under the new plan and get it in January irrespective of what I have on hand.  That should give me a safety net of some extra medication in case this catch 22 comes up in the future.  

 

Great suggestion.  This will save me a lot of grief. Thanks so much.

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5 hours ago, Kwaj girl said:

Don't know if you're just on Levothyroxine generic...but you can get a 3-month supply @ Walmart for $10 WITHOUT going thru your insurance.  I have been able to get an early refill more than once on this.

 

Ah, it is all coming back to me now.  I get the Levo...at Walmart now, can't beat that price!  But it was a common medication that Publix gives for free (ever check out their free drugs? They beat Walmart!).

So my relationship is between Publix and me, right?  No.  Caremark for some reason has control over the Rx and it was that medication that I had to get the emergency override.  And the doc writes the script for 90 days and Caremark won't let them give me more than 30 days at a time.  AAKKKK

 

5 hours ago, cangelmd said:

MD here - this is pretty common now with widespread pharmacy benefits management plans.

Makes no sense to me, but I'm not the kind of MD that writes lots of scrips, so maybe there is something about the policy that I don't understand - I do know that it is NOT just pain meds and not just expensive non-generic meds either. I do think an MD can write you a new scrip or a bridge scrip as someone else mentioned, at least on non-Medicare plans.

If you are a frequent traveler with multiple meds, consult with your pharmacist about options. Medicare rules are so obscure that I wouldn't be surprised to find out that you can't technically do what was mentioned above - I don't KNOW that , but I just wouldn't be surprised.

When the time comes - traditional Medicare for me, with a strong supplement - no Medicare Advantage as long as I can afford the premiums!

 

I think I am going to get Plan G.  That is a very strong supplement.

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3 minutes ago, Muushka said:

 

Ah, it is all coming back to me now.  I get the Levo...at Walmart now, can't beat that price!  But it was a common medication that Publix gives for free (ever check out their free drugs? They beat Walmart!).

So my relationship is between Publix and me, right?  

I get Amlodipine for free at publix...you are right...can't beat it. No Blue Cross interference 

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Caremark sometimes restricts local refills to 30 days if the 90 day script is available thru Caremark mail order. I get 2 generic drugs for free from Caremark that would actually cost more at Sam's.

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10 hours ago, Muushka said:

 

Ah, it is all coming back to me now.  I get the Levo...at Walmart now, can't beat that price!  But it was a common medication that Publix gives for free (ever check out their free drugs? They beat Walmart!).

So my relationship is between Publix and me, right?  No.  Caremark for some reason has control over the Rx and it was that medication that I had to get the emergency override.  And the doc writes the script for 90 days and Caremark won't let them give me more than 30 days at a time.  AAKKKK

 

 

I think I am going to get Plan G.  That is a very strong supplement.

90 day prescriptions are usually only available if you use the mail order option through your Medicare plan, but they are available.  Publix only fills the order, Caremark must be either your Part D carrier or the pharmacy benefits manager hired to manage the claims which means they also control the pharmacy network you can use and the approval of all medications.

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T me the take home message is evaluate the terms and conditions of all Medigap and Medicare Advantage and regular Medicare for that matter. Look at what your health needs are now, and what your obligations will be if you have to go to the hospital under different plans.

all of these are expensive, and their ultimate goal is to make money (and in the case of Medicare, not spend money), not to take care of you - all the advertising works very hard to obfuscate that goal, even for BCBS which technically doesn’t make a profit.

You are the only person who has your own best interest, both financial and health wise, in mind.

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2 hours ago, Lisah101 said:

90 day prescriptions are usually only available if you use the mail order option through your Medicare plan, but they are available.  Publix only fills the order, Caremark must be either your Part D carrier or the pharmacy benefits manager hired to manage the claims which means they also control the pharmacy network you can use and the approval of all medications.

Again, BCBS, not Medicare.  And since the drug is free, why would there be a claim?  

As opposed to 2 other meds that I pay for OOP (like the Levo... and another), they give me 90 day supply.

Why the discrepancy?

 

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Thanks for the warning.    I ran into this but just contacted my Doctor and he wrote a new prescription with a 90 day  supply.  May not work on all drugs but a quick way to work around limitations.  I have Kaiser Senior Advantage and they will fill 90 day supplies either by mail order (usually 1-2 days) or picking up at one of their pharmacies. 

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As I pointed out, SilverScript will only give you a 30 day supply, if you need to refill early.....even though I normally get a 90 day supply at my local drug store.   It has nothing to do with retail or mail-order.    

 

I believe this is a caremark policy, so anyone whose plan processes through caremark may have this issue.

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Just now, ghstudio said:

As I pointed out, SilverScript will only give you a 30 day supply, if you need to refill early.....even though I normally get a 90 day supply at my local drug store.   It has nothing to do with retail or mail-order.    

 

I believe this is a caremark policy, so anyone whose plan processes through caremark may have this issue.

I used to work for Caremark - back then the policy was 90 days but only if you used Caremark mail order service. If you used retail pharmacy then you were limited to 30 days at a time.

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Will not necessarily fix the OP's problem, but if any of you live near a Costco (Sam's Club too I believe have similar pricing) you may want to join their prescription program which is not connected to any insurance that you may have (Part D in most cases in this thread). We have found out through trial and error that their program, for generics especially, can beat the crap out of Part D Plans. For example, I have one drug that is not on any Part D program. For a 90 day Rx at any standard drug store it costs over $500. At Costcos it is around $50. No typos in the the last sentence, a 10x difference for the exact same pill/manufacturer. We have found savings on nearly all generics even those that are on Part D Plans (co-pays are more than just paying cash). When Costco receives a new Rx they compare the person's Part D Plan to their price and then they pick the least expensive (they also accept GoodRx, but don't waste your time here, they will beat it too even their own GoodRx coupon LOL). We have saved way more than enough money to pay for our annual membership fee many times over. Only two downsides; not open on Sundays, and no drive throughs at least not here). For the money, I can adapt.

 

You do not need to be member of Costco to get access to the pharmacy, but I am not sure if non-members can join their Rx Program. I know that when you apply (on paper) it does ask for your membership number. 

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We have sometimes posted (on various threads) about the prescription drug problem, but this is the first time we saw the issue on the Celebrity board.  The issue goes way beyond Silver Script and Medicare Part D....although that is certainly an issue.  Similar issues exist with many other Prescription Plans.  And perhaps the most difficult issue is faced by those who truly need narcotic scripts and are planning a long trip.  This topic is more apropos for the lines that have a lot of longer itineraries...especially World Cruises that are over 100 days long (one cruise line did a 180 day cruise).   In the USA, in order to try and curtail narcotic abuse, scripts for those drugs are limited to 30 days!

 

There are no easy solutions.  Many of us who have recurrent scripts and do a lot of travel have learned various tricks to build up some drug inventory.  For those that go to Mexico (we live in Puerto Vallarta part of the year) it is possible to obtain many prescription drugs without a script (this does not include narcotics)… or can even easily obtain a script if it is necessary.  We have talked to numerous travelers who will buy an extra supply of various drugs (i.e. BP med, Cardiac med, etc) when in Mexico.  Of course you will have to pay "out of pocket" for those med.  We know some who do World Cruises who have asked their cruise line to stock a specific drug (getting approval is hit and miss).

 

This is a topic that some folks should discuss with their own physician who can sometimes help find a  solution.

 

Hank 

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1 hour ago, sptrout said:

Will not necessarily fix the OP's problem, but if any of you live near a Costco (Sam's Club too I believe have similar pricing) you may want to join their prescription program which is not connected to any insurance that you may have (Part D in most cases in this thread). We have found out through trial and error that their program, for generics especially, can beat the crap out of Part D Plans. For example, I have one drug that is not on any Part D program. For a 90 day Rx at any standard drug store it costs over $500. At Costcos it is around $50. No typos in the the last sentence, a 10x difference for the exact same pill/manufacturer. We have found savings on nearly all generics even those that are on Part D Plans (co-pays are more than just paying cash). When Costco receives a new Rx they compare the person's Part D Plan to their price and then they pick the least expensive (they also accept GoodRx, but don't waste your time here, they will beat it too even their own GoodRx coupon LOL). We have saved way more than enough money to pay for our annual membership fee many times over. Only two downsides; not open on Sundays, and no drive throughs at least not here). For the money, I can adapt.

 

You do not need to be member of Costco to get access to the pharmacy, but I am not sure if non-members can join their Rx Program. I know that when you apply (on paper) it does ask for your membership number. 

I will check out Costco.  Thank you!

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