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Medicare "Donut Hole" Scam?
11/14/2023 | Tnoldman

Posted on 11/14/2023 1:34:59 PM PST by TNoldman

I am taking Prescribed Eliquis 5 mg Blood Thinner. With my UHC Advantage Plan I can get a 90 day supply(180 pills) for $95. The Drug cost is shown a $1780. My "Donut Hole" account is charged almost $1700. I can't believe UHC is paying Pfizer $1700. UHC must get a big discount??

After about $4800. in the "Donut Hole" account I must pay 25% of the full cost - about $450.

I am able to buy Eliquis(apixaban) via a Certified Canadian Pharmacy from India for $95. (120) pills. My Doctor has approved and they results are the same.

Medicare or Medicare participants are getting ripped!

Can anyone explain or suggest a solution.


TOPICS: Health/Medicine
KEYWORDS: donuthole; eliqus; medicare; prescription; vanity
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To: metmom
"We had supplemental insurance as a retiree, but found out that if Medicare rejected the claim, they did too."

ding, ding, ding....we have a winner....

same thing goes for treatments....if medicare doesn't think you need it, no other insurance is going to cover it...if medicare doesn't think you need to be admitted to a hospital, they will not pay for it....they'll play games like they will give the doc up to 48hrs to come up with a reason to admit the patient otherwise, patient is decertified and has to do self pay.

in my state, you have to run oxygen levels at 88% or below to qualify for home oxygen...and they will not pay nor other wise provide it...sometimes the docs can write in something like "oxygen with activity"....and it'll get covered...

41 posted on 11/14/2023 3:56:20 PM PST by cherry
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To: All

Bump


42 posted on 11/14/2023 4:01:03 PM PST by rockrr ( Everything is different now... )
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To: MomwithHope

“”There isn’t a generic version of either xarelto or eliquis.””

True..I submitted an application to Bristol Myers for prescription assistance for Eliquis when I got in the donut hole. That ends in December and I would have to apply again but I’ll not do it until 2024 donut hole comes around. My copay is $47.00 before that and I can handle that but I can’t handle it after the donut hole. The paperwork was handled very fast and three bottles of 2.5 mg Eliquis was mailed immediately. I take one 2.5 mg. 2x a day and I will cut that to 1x day if it doesn’t take me through the end of the year.

Learned from my pulmonologist this month that they are not getting any more samples of COPD medications/inhalers etc. So I’m paying the “donut hole” price for that and received a letter today from my Medicare Advantage carrier that they will not cover Symbicort next year... The maker of Symbicort does NOT offer prescription assistance.

I didn’t intend to shop for different coverage for 2024 but based on the latest info about Symbicort from my carrier, I may have to.

It’s the blood thinner and the pulmonary medication that puts me in the donut hole pretty fast each year. Getting samples to tide one over has never been a problem until now and both the pulmonologist and cardiologist say the same thing about no samples now from any company.


43 posted on 11/14/2023 4:16:39 PM PST by Thank You Rush ( )
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To: jimwatx

Warfarin rat poison is even cheaper than medical warfarin. The only difference is the concentration in the pellet (and it’s shaped like a pill, too).
0


44 posted on 11/14/2023 4:25:23 PM PST by norwaypinesavage (The power of the press is not in what it includes, rather, it's in that which is omitted.)
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To: metmom

Thank you!!!


45 posted on 11/14/2023 4:26:41 PM PST by joesbucks (It's called love-bombing. Claiming he's saving the world. This is a cult. Just back away. )
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To: Thank You Rush

I have Priority Health Medicare. With extra drug coverage. We are just screwed. I take two 5 mg a day. I will probably do the same thing next fall.


46 posted on 11/14/2023 4:36:26 PM PST by MomwithHope (Forever grateful to all our patriots, past, present and future.)
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To: metmom

I don’t deal with a pharmacy, I deal with a Pharma wholesaler.

go to Indiamart.com


47 posted on 11/14/2023 5:00:50 PM PST by Captain Peter Blood
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To: joesbucks

Which Canadian pharmacy?

CanadianPharmacyDrugstore.com


48 posted on 11/14/2023 5:05:25 PM PST by TNoldman (AN AMERICAN FOR A MUSLIM/BHO FREE AMERICA. (Owner of Staris and Bars Flags))
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To: P-Marlowe

I don’t takes any medication that is not available as a generic.

Why are you not on a generic blood thinner?

Eliquis is safe and doesn’t require frequent blood tests. No generic.


49 posted on 11/14/2023 5:08:28 PM PST by TNoldman (AN AMERICAN FOR A MUSLIM/BHO FREE AMERICA. (Owner of Staris and Bars Flags))
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To: P-Marlowe

Why are you not on a generic blood thinner?
**********
The best blood thinner is Eliquis and there is no generic yet.


50 posted on 11/14/2023 5:08:28 PM PST by yldstrk
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To: TNoldman

I was put on eliquis 3 months ago for a blood clot, It was a little over $2000.00 for the 4 month supply, no insurance. I will be getting another prescription for 2 months worth in a week or so. I will be ordering Online thanks to you. Thank You very much.

You are correct though, everyone is getting ripped off, mainly because the quisling politicians are all bought and paid for by big pharma.


51 posted on 11/14/2023 5:22:42 PM PST by eyeamok
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To: DesertRhino

Medicare part D has shrunk the donut but it still affects cost.
For 2023 it’s like this.
Deductible: If you’re enrolled in a Medicare prescription drug plan, you may have to pay up to the first $505 of your drug costs, depending on your plan.5 This is known as the deductible. Some plans don’t have a deductible, or have a smaller deductible, but no Part D plan can have a deductible in excess of this amount.
Initial coverage level: During the initial coverage phase (after the deductible is met, assuming the plan has a deductible), you pay a copayment or coinsurance, and your Part D drug plan pays its share for each covered drug until your combined amount (including your deductible) reaches $4,660.3
Entering the donut hole: Once you and your Part D drug plan have spent $4,660 for covered drugs, you will be in the donut hole. Prior to 2011, you would have had to pay the full cost of your prescription drugs at this point. But now that the ACA has closed the donut hole, you’ll pay 25% of the cost of your drugs while in the donut hole. Again, the donut hole is “closed” because 25% of the cost is the same as what you’d pay in the initial coverage level with a standard plan design. But since most plans don’t have standard designs, it’s very likely that 25% of the cost of your drugs (while you’re in the donut hole) is going to amount to more than you were paying before you entered the donut hole.
Leaving the donut hole: The donut hole continues until your total out-of-pocket cost reaches $7,400 in 2023 (a significant increase from the $5,100 threshold that was applicable in 2019).6 This annual out-of-pocket spending amount includes your yearly deductible, copayment, and coinsurance amounts, and it also includes the manufacturer’s discount on the drugs that you get while in the coverage gap. This means that although you only pay 25% of the cost of your medications while in the donut hole, 95% of the cost of your brand-name drugs will be counted towards getting you to the $7,400 level where you’ll get out of the donut hole and enter the catastrophic coverage level. But for generic drugs, only the 25% that you pay will count towards getting your spending to that $7,400 level where you’ll leave the donut hole, since there’s no manufacturer discount for those drugs.

I have not checked 2024 yet...I think the deductible is $525


52 posted on 11/14/2023 5:36:21 PM PST by Adder (End fascism...defeat all Democrats.)
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To: MomwithHope
There isn’t a generic version of either xarelto or eliquis.

Generics for Eliquis are FDA approved but not readily available in US.

Link

53 posted on 11/14/2023 5:45:21 PM PST by SC DOC (A)
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To: SC DOC

Thank you for that link, it is hopeful. I get it, it’s all about the money. Just think how many more people are taking blood thinners because of the vax.


54 posted on 11/14/2023 6:03:33 PM PST by MomwithHope (Forever grateful to all our patriots, past, present and future.)
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To: Thank You Rush

“I submitted an application to Bristol Myers for prescription assistance for Eliquis “

I find that every one of these Big Pharma outfits, want to see my tax returns, they want my SSN, etc. I doubt they are in the business of securing anybody’s data !!


55 posted on 11/14/2023 6:19:07 PM PST by George from New England
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To: P-Marlowe

The craziest one I’ve seen is one for menopause. It starts with women suffering hot flashes then touts the drug and how it eases menopausal symptoms. At the end when it lists the side affects, one of them is hot flashes!

Geesh, people are so gullible.


56 posted on 11/14/2023 6:57:55 PM PST by Jvette (Still MAGA)
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Comment #57 Removed by Moderator

To: P-Marlowe

I’ve been on both: warfarin and now Eliquis.

Every time I cut myself on warfarin I bled a large amount and it took forever for it to stop bleeding, I’ve cut myself once on Eliquis and it bled a little more than usual, and took maybe three times as long to clot, not nearly as bad as warfarin.

Plus, on warfarin I need once a week blood draws and I had to tightly control my green leafy vegtables intake, which sucked because I eat a lot of broccoli, spinach, chard, kale, etc.

I’m really grateful for Eliquis.


58 posted on 11/14/2023 7:21:09 PM PST by Sir_Ed
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To: P-Marlowe

“Why do you need some $1500 a month drug that is basically aspirin with Prilosec?”

How some FReepers can be so massively misinformed I don’t know.


59 posted on 11/14/2023 7:32:20 PM PST by steve86 (Numquam accusatus, numquam ad curiam ibit, numquam ad carcerem™)
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To: All

bookmark. i guess i’m sad, but not that shocked given recent history, to see all these folks so knowledgeable on pricy blood thinners.


60 posted on 11/14/2023 7:50:27 PM PST by dadfly ( )
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