The Med Diva

An insider's guide to Medicare Part D and more

Archive for the category “Prescription drugs”

Playing Russian Roulette with online pharmacies: If it walks like a duck, quacks like a duck, it may not be a duck

The other day I heard a coworker’s conversation with his wife on the telephone. I did not like what I had heard.

First let me state that I was not snooping on my coworker. I work in a large office area that has many cubicles and very high ceilings. The acoustics in here are great–if you want an audience. This worker is in his late sixties, and he tends to speak loudly all the time. So it’s impossible not to overhear his conversations (unless I get up and leave my desk).

During this particular conversation with his wife, he was apparently instructing her to use her Medicare Part D benefit to fill an expensive prescription one time at the local pharmacy. After that one time, he advised, she could fill the script through an online pharmacy to save money.

I wanted to jump over my cubicle right there and then and warn him of the dangers of using online pharmacies, many of which are stocking their “shelves” with unsafe, counterfeit drugs. I restrained myself, and decided to blog on the subject  instead.

In March 2011, CBS’ 60 Minutes reported on the proliferation of counterfeit drug makers, who often use ingredients such as highway paint, floor wax, and boric acid to keep prices down. According to the report, many of these drugs are sold by rogue Internet pharmacies, including those that claim to be real Canadian pharmacies but are in fact not legitimate and not based in Canada. The abundance of fake drugs is in fact so great that any consumer who purchases drugs through an online pharmacy is playing Russian roulette.

During a raid on a fake drug manufacturing plant in Lima, Peru, a global security team made up of former FBI, Homeland Security, and narcotics agents, and headed by John Clark of Pfizer, discovered counterfeit Pfizer drugs lying in dirty pans in a filthy apartment. “If the consumer ever realized that products that they’re putting inside their bodies come from this, from dirty water…insects and everything else getting into it…I think they’d be horrified,” Clark said.

The issue of illegitimate online pharmacies is of such great concern in this country that combating these fake drug sellers has even garnered bipartisan support.  This week, Senators Dianne Feinstein (D-Calif.) and Jeff Sessions (R-Ala.) introduced the Online Pharmacy Safety Act of 2011 to stop criminals from exploiting the Internet to illegally sell prescription drugs. The legislation targets fraud associated with illegitimate online drug sellers, particularly those who sell counterfeit drugs, provide drugs without a prescription, or take money without providing anything in return. The bill, which requires the Food and Drug Administration to establish a registry of legitimate online pharmacy websites, is co-sponsored by Senators Charles Schumer (D-N.Y.) and John Cornyn (R-Texas).

Better options to lower your drug costs

There are much better ways to lower your drug costs than by filling your prescriptions through online pharmacies. Using lower-cost generic drugs or legitimate mail-order pharmacies owned and operated by U.S. health plans and pharmacy benefit managers are two of the best ways to save. Discount prescription drug cards and prescription savings programs are also helpful if you are not yet eligible for Medicare, or you can check with your state to see if it offers help paying drug plan premiums and/or other drug costs.

Medicare and Social Security have a program for people with limited income and resources that helps you pay for your prescription drugs. If you qualify, you could pay between $1 and $6 for each drug. To apply, visit or call 1-800-772-1213. TTY users should call 1-800-325-0778.


No “Oops” Allowed: 3 Facts to Remember About Medicare Part D Open Enrollment

In honor of Texas Governor Rick Perry’s most recent gaffe during the CNBC Republican presidential debate, I want to briefly review three questions about Medicare Part D Open Enrollment that seniors have often asked me. You don’t want to go “oops” when it comes to something as important as your health, so please remember the answers!
1. Do I have to re-enroll every year if I want to keep the same prescription drug plan?
No, if you are happy with your plan and it is meeting your needs, you do not need to do anything – your coverage will automatically continue each year. However, if your current plan has earned less than 4 stars from Medicare, or will no longer cover one or more of your medications in 2012, you should consider switching to another plan that is better suited for you.

It’s also a good idea to use the Medicare Plan Finder tool each year to make sure you’re not paying more than you have to for your prescription drugs. Recent studies show that seniors can save a few hundred dollars or more by doing some research and switching Medicare Part D plans.

2. My spouse and I use the same insurance company for our health coverage. Is it a good idea for us to enroll in the same prescription drug plan, too?
For most couples, it is not a good idea to choose the same Medicare Part D plan. Chances are you have different health needs and take different medications, so picking the same plan is usually not the best option.

For example, you may take only one generic medication, so your needs are minimal. Therefore, you would probably choose an inexpensive plan that has a low monthly premium but no extra bells and whistles. Your spouse may be taking several medications for a chronic condition such as diabetes or asthma, and therefore needs a plan that offers better coverage, a higher star rating, and a mail-order pharmacy for extra savings. It does not make sense for you to pay more for coverage you don’t need, or for your spouse to be enrolled in a plan that does not meet his or her prescription drug needs.

3. If I sign up for a Medicare Part D plan today, will my coverage start immediately?
When you join a Medicare plan during the Open Enrollment period, your new coverage will not begin until January 1st of the following year. So if you join a plan on November 15, 2011, your coverage will begin January 1, 2012. You will continue to be covered under your current prescription drug plan through December 31. You will be automatically disenrolled from your current plan as soon as your new coverage begins on January 1st.

And don’t forget: Open Enrollment ends early this year on December 7!

’Tis the season to shop: Seniors could save hundreds of dollars by switching Medicare Part D plans

Don’t Miss Your Chance to Save: Open Enrollment Ends December 7

Whether you’re a senior on Medicare, a caregiver for a Medicare beneficiary, or just helping your parents with their money matters, ’tis the season to go shopping. Even if you are satisfied with your current prescription drug plan, you could save a few hundred dollars or more by comparison shopping and choosing a plan that better meets your needs.

According to a recent survey of 71,000 people enrolled in Medicare prescription drug plans, 81 percent lowered their costs by an average of $298 by switching plans from 2006 to 2007. This number is promising, because it shows that even though Medicare Part D is complex and often confusing, seniors are using available tools and services to choose plans that cost them the least based on their prescription drug use.

Despite the results of this one survey, however, advocates like me still have a long way to go to convince Medicare beneficiaries that it’s a good idea to compare plans every year during the Open Enrollment period. According to the Centers for Medicare and Medicaid Services, only about 7 percent of the 17 million seniors on Medicare drug plans switch plans each year. Another survey conducted by KRC Research confirms CMS’s findings, with two out of three seniors stating they are unlikely to shop around for Med D plans. Medicare experts say this suggests that millions of beneficiaries could be paying more than they have to for prescription drug coverage.

Top 5 Reasons Why Seniors Don’t Make a Switch

According to senior advocates and insurance advisors, there are several reasons why people are hesitant about switching their drug plans:

1. Many believe that once they join a drug plan, they should stick with it long term, just as they stayed with the same private health insurance plan for many years before enrolling in Medicare.
2. A lot of seniors aren’t as aware as they should be of changes to the Part D benefit or of the opportunity to change plans during the Open Enrollment period.
3. With up to 30 or more drug plans on the market in each state, many seniors get overwhelmed or frightened at the thought of changing plans, even if another one would better suit their prescription drug needs and lower their costs.
4. Although Medicare’s easy-to-use Plan Finder tool allows beneficiaries to enter their medications to find a plan with the lowest overall annual costs, many seniors are uncomfortable going online or unable to use computers.
5. Many seniors are very satisfied with their current plan—even if it does cost more—and feel that “if it’s not broken, why fix it?”

Yes, shopping around and switching plans does take some time and can be a bit daunting.  But keep in mind these two good reasons for adding this annual task to your “to do” list:

• Medicare plans can and often do make annual changes to their offerings or formulary (list of covered drugs), which can increase drug costs by thousands of dollars, or make it more difficult for you to get certain drugs.
• If your drug needs have changed since you last enrolled in a Part D plan, your current plan may not be meeting all of your needs.

Remember, the Medicare Part D open enrollment season, which began October 15, continues only through December 7. If you need more information on Medicare Part D coverage, visit the Medicare website or call 1-800-MEDICARE.

No trick or treat: Kids are getting high on drugs instead of candy

National Drug Take-Back Day Scheduled for Saturday, October 29

Chances are, if you are reading this blog, you or a loved one is taking some kind of prescription medication, whether for a long-term chronic condition or short-term illness. Chances are also good that at least one young person you know is abusing prescription and/or over-the-counter drugs to get high.

 According to a National Survey on Drug Use and Health (September 2009), 70% of teens age 12 to 17 have gotten high on drugs that they obtained from a friend or relative. Many of these teens are getting them online or free from friends, who in turn are getting these drugs by going through their parents’ or grandparents’ medicine cabinets. More teens abuse prescription drugs than any illicit drug except marijuana, and the main reason is because they are readily available. What’s even scarier: Kids as young as 12 and 13 years old report that prescription drugs are their drugs of choice! (What happened to the good old-fashion sugar high from hoarding all the Halloween candy?)

What kind of prescription drugs are teens abusing?

1. Painkillers
Painkillers are drugs commonly prescribed for pain and include: Vicodin, Tylenol with Codeine, OxyContin, and Percocet.
2. Depressants
Depressants (aka downers, sedatives, or tranquilizers) are prescribed to treat a variety of health conditions including anxiety and panic attacks, tension, severe stress reactions, and sleep disorders. They include: Klonopin, Nembutal, Soma, Ambien, Valium, and Xanax.
3. Stimulants
Stimulants, or uppers, are usually prescribed for attention deficit/hyperactivity disorder (ADHD), but they are also used to treat other conditions such as asthma, respiratory problems, obesity, and sleep disorders. Stimulants include Concerta, Dexedrine, and Ritalin.

What can I do to protect the young people in my life?

In addition to talking to children or grandchildren about the dangers of abusing prescription and OTC drugs, you can take the following steps to prevent these dangerous substances from winding up in the wrong hands:

1. Take a survey of all the medications in your home. What drugs do you have? Where are they kept? Would you know if any were missing?
2. Safeguard all drugs at home by keeping them locked out of reach when guests, baby sitters, or pet sitters are in the house. (The child-proof caps are not going to cut it!)
3. Ask friends and family to safeguard their prescription drugs, too.
4. Properly dispose of old or unused medicines.

How do I dispose of old and unused medications?

In its ongoing effort to fight prescription drug abuse in the United States, the U.S. Drug Enforcement Administration (DEA) has scheduled Saturday, October 29, as National Prescription Drug Take-Back Day. Between 10 a.m. and 2 p.m., you can safely throw away your unused prescription drugs at designated collection sites around the country. To find a site closest to you, click here for the U.S. Department of Justice database and enter your zip code.

For additional information

For more information on National Prescription Drug Take Back Day, click here. The National Youth Anti-Drug Media Campaign, which produced the video below, has also created the AntiDrug website, which provides parents, grandparents, and other adult caregivers a wealth of resources to help you raise and mentor drug-free kids.

Always Read the Fine Print When Comparing Medicare Part D Plans

On Tuesday, drugstore operator Rite Aid Corp. joined the prescription drug plan bandwagon by introducing a new Part D plan through a partnership with Envision Insurance. This announcement follows closely on the heels of new plans from CVS Caremark Corp. and Walgreens Co.—both introduced this month–and Wal-Mart Stores Inc., which launched its plan with Humana last year.

Like Humana has done with its low-cost Walmart-Preferred Rx Plan, big chains such as Rite Aid and Walgreens are trying to lure seniors into their plans by advertising either low monthly premiums, low co-payments, or even $0 co-payments for generic drugs. One of the reasons they can charge such low prices is because it’s a great way to fill as many prescriptions as possible and get more shoppers into their stores to buy other products.

The catch for the consumer, though—of course there’s a catch—is that these drugstore-sponsored plans have highly restrictive pharmacy networks. If you purchase your drugs from a pharmacy that is not in the network, you will more than likely have to pay more than what is advertised in the large print.

A $10 co-payment is not the same as a $1 co-payment.

For example, if you go to the website for Humana’s Walmart-Preferred Rx Plan, you will see that the plan offers a $1 co-payment for preferred generics. However, read the fine print, and you’ll discover that in order to pay only $1, you have to use a preferred pharmacy, which includes, surprise, surprise, pharmacies at Walmart, Walmart Express, Sam’s Club, and Walmart Neighborhood Market. The price jumps to $10 if you use any other pharmacy in the restricted network. For preferred brand-name drugs, you’ll pay a 20% coinsurance if you use a Walmart pharmacy, but almost double (37%) anywhere else within the network.

How close is a large chain pharmacy to your home?

Last year, despite my objections, a family member enrolled in the Humana plan. She loved the low monthly premium, but she hated that she would have to use a Walmart pharmacy to get the best prices for her medications. The closest Walmart is about 25 minutes from her home, so not only does she have to pay extra for gas, but it takes her more than an hour to get there and back by the time she parks and waits on line. (I’m still trying to convince her to switch to the mail-order pharmacy!)

The moral of this story is two-fold: Always read the fine print whenever you are comparing prescription drug plans, and make sure that your local or favorite pharmacy is a preferred pharmacy in the plan’s network. Large, national prescription drug plans from companies like Blue Cross Blue Shield, Medco, or Wellcare may have higher premiums, but if you prefer using a smaller retail pharmacy in your hometown, your total costs may even out in the end.

Reminder: Open Enrollment is now through December 7, 2011.

The Medicare Coverage Gap Discount Program:

What the Drug Makers Don’t Want You to Know, Part II

In discussing the Medicare Coverage Gap Discount Program yesterday, I explained why lower-cost generics are still the best way to lower your drug costs—even with the 50% discount on brand-name drugs in the Coverage Gap. Now I’ll share a little-known detail about the Discount Program that could affect you if you’re still using brand-name drugs.

Under the Discount Program, you’re entitled to a 50% manufacturer discount on covered Part D brand-name drugs when you reach the Coverage Gap (aka donut hole). So if the full cost of your brand-name drug is $130, for example, you’ll pay only $65 in the Gap, plus any nominal dispensing fee.

This all sounds wonderful, but we’re dealing with Medicare, so of course there’s a catch: The drug manufacturer has to sign an agreement with the Centers for Medicare & Medicaid Services (CMS) to participate in the program. And guess what? Not all manufacturers are participating in this program.

If a drug manufacturer does not agree to participate in the program:
• Its drugs will not be covered under Medicare Part D.
• Your plan cannot grant a coverage exception if you’re taking one of this company’s medications. 
• If you must take this particular drug, you’ll have to pay full price for it.  

Adding insult to injury

Here’s the real kicker: If you pay the full price for your drug because the manufacturer isn’t participating in the Discount Program, your out-of-pocket costs for this drug will not count toward getting out of the Gap and into the Catastrophic Coverage stage. So you could stay trapped in the Gap longer as you to continue to pay your monthly premium.

What drug manufacturers are participating in the Discount Program?

CMS has tried to be helpful by publishing a list of manufacturers that have agreed to participate in the program. But this listing doesn’t make a lot of sense unless you have a PhD in Med D. You can check it out by clicking here and then clicking on “2011 Labeler Code File” if you’re feeling adventurous. But if your doctor prescribes a new brand-name drug, I suggest you call your plan to make sure it’s covered. If it’s not, there may be a lower-cost generic that will work just as well for you.

Remember: Medicare Open Enrollment is now through December 7, 2011.

Saving Money with the Mail-Order Pharmacy: Give it a Try!

Open Enrollment for 2012 is October 15 through
 December 7, 2011.

  You may recall a very popular 1970s TV commercial for Life Cereal, in which two brothers are discussing “some cereal” that’s “supposed to be good for you.” Neither wants to give it a try, so they push it toward their little brother, Mikey. Turns out little Mikey, who supposedly hates everything, really likes it.

For many seniors enrolled in Medicare prescription drug plans, a similar scenario often plays out. You may be constantly bombarded by letters from your plan telling you that switching to a mail-order pharmacy is good for you because it will help youlower your out-of-pocket costs and delay entering the Coverage Gap (donut hole). But you’re reluctant to give it a try for various reasons (procrastination, perhaps?) so you toss the information in the garbage.

I have to admit I was a little hesitant to try my mail-order pharmacy at first, simply because I didn’t want to deal with the paperwork involved. I thought it would be a hassle to switch my one prescription from my favorite retail pharmacy, but when I used my plan’s price comparison tool on its website and discovered I would pay $100 less a month with mail, I immediately made the switch. 

Guess what? It wasn’t a hassle at all! The customer service rep did all the work for me–she even called the doctor with my permission to get my prescription–and in a few days my medication arrived in a secure package in my mailbox.

Today I have nothing but good things to say about my mail-order pharmacy. I can order up to a 3-month supply of my medication for a lot less money than a 30-day supply at the local pharmacy. My drugs arrive in my mailbox, so I don’t have to drive to the pharmacy and use up gas or wait 15 minutes in line. (There’s never a line at my mailbox!)

If I have to work late, I don’t have to worry about the pharmacy closing before I get home — after all, my mailbox never closes!  And If I have a question about my medication I can call my plan and talk to a pharmacist any hour of the day, for as long as I want, without having to worry that I’m holding up the line. Best of all, my mail-order pharmacy sends me automatic refill reminders by e-mail, and I can order refills online.

I like to tell my friends and family that switching to mail order is like the switch we all made from typewriters to computers. Many of us were reluctant to try computers because switching required us to change our ways and learn a new skill. But wasn’t it wonderful once we got the hang of the Internet, e-mail, word processing, and Facebook? We like it! Hey Mikey!

Why It’s Important to Talk to a Real Person When Comparing Medicare Part D Plans

It recently came to my attention that the Plan Finder Tool on the Medicare website has a few database glitches, resulting in wrong pricing information for some health and prescription drug plans.

For example, one national Part D plan discovered last week that the pricing information for specialty drugs was incorrect when visitors to the website searched to find out how much their drugs would cost with this plan. I also heard from an insurance broker in Arizona, who told me she was also experiencing pricing errors while doing searches for her clients.

For years I have been telling Medicare beneficiaries that it is crucial to confirm the cost of your drugs each year during Open Enrollment. Medicare Part D plans can (and often do) raise co-payments or move drugs from lower-priced tiers to higher-priced tiers. So just because you are paying $10 for a drug right now doesn’t mean it will still be $10 in 2012.

That’s why even if you’re very pleased with the plan you have this year, you really should check the prices on all the medications you are taking for next year. I know it’s a major pain in the you know what–and one of the main reasons we all love to hate Medicare Part D–but by not taking the time to do this due diligence every year, you could be spending a lot of money than necessary.

Use Plan Finder as a Starting Point Only

So now we get back to my original topic. One of the online tools I always talk about is Medicare’s Plan Finder. Although I still highly recommend this site as a starting point for searching and comparing plans, the data glitches has me worried, because many seniors may be getting misleading information. Can you imagine thinking your drug is going to cost $50 a month with the XYZ Plan (based on the Plan Finder website), only to find out in January that it really costs $150 a month?!

Technology is a wonderful thing, and it has certainly made our lives easier. But when it comes to something as important as pricing your prescription drugs, my advice is to do it the old-fashioned way. Use Plan Finder or the plan’s website as a starting point, but then call your plan (or the new plan that you’re interested in joining) and speak to a real person. It may take longer to have the customer service representative look up each drug for you, but for peace of mind it’s well worth it.

Always Keep Records

Finally, when you do speak to the plan representatives on the phone, take careful notes and keep these notes in a safe place. For example, take note of the date and time you called, the representative’s name, and the specific dollar amounts that he or she provides for each of your medications. That way if there is a pricing error and you are charged more than you were told, you have all the necessary paperwork to argue your case. If you’re also using a website to get your medications costs, make sure to print out the pages and keep them safe with your records.

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