Medicare Questions

I hate it, myself. Our primary insurance that was mr. mm's from work is now allegedly the secondary insurance, and our rates for that insurance went down, but I am getting nailed to the wall with prescription expenses. Some of the meds I am on for my Mast Cell Disorder are ridiculously expensive and even with the so-called co-pays, would bankrupt us because of the coverage gap.

I have medicare Part B and D but I have no way of knowing how the different providers do with coverage. IOW, would a different provider cover more of the cost or is it set by Medicare?

Also, one thing I would do different, if I knew, is that I would have refilled every prescription I had in April, while still under our regular insurance. I had to get some Epi-Pens because mine had expired, and paid a ridiculous price for two, WITH the co-pay. Over $200.

You really don't understand how it works at least for some drugs. It took some hard lessons for me to understand.

“......The older meds are effective still and off patent, which makes them affordable. Always ask for generics, which is the same drug just not “brand name”.........”

That may be true in some circumstances, but not all.

One of the two medications I talked about was a topical low Testosterone medication. Originally, my health insurance paid for Androgel 1%. Then the patent expired and they switched me to a generic, which after my doesage was adjusted was fine, although it took 6 months and several blood draws and dose adjustments.

Then Androgel came out with I think it was a new patented drug, Androgel 1.6%. The insurance company would no long pay for the generic. My pharmacist said there was probably some mfg. discount for a new product or a kickback causing them to only pay for the patented medicine (with a higher copay). It also required a significant amount of time to again adjust my dosage.

I appealed the health insurance company's requirement that I do a patented drug and not a generic. I went all the way to the State Insurance Commissioner. I learned that the insurance company gets to make those decisions, I lost my appeal.

Sometimes generics are not the best option.

That is when I went and looked around and talked to a number of pharmacists to explore my options. I found a good compounding pharmacy that provided a quality product at less than the price of a generic and haven't looked back. While not covered by insurance, my payments are less than my copays would have been with what the insurance company would have charged for an “approved/covered” drug.

The whole health insurance industry is subjective, arbitrary, and you really need to pay attention to details.

GoodRX is a great way to get lots of drugs at very low prices, mostly at or below copays of insurance companies. You always need to check. If I am every prescribed a new drug, I will not have the doctor send the prescription to a pharmacy, but check the cost of the drug out on GoodRx, then call the insurance company to find out the cost of my copay on that drug, then go to the pharmacy that GoodRx will support and ask that pharmacist how I can purchase the drug on the prescription for the lowest price, GoodRx with no insurance, or insurance and copay or “some other option,” such as compounding or an other discount plan.

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