I told the company "no thanks"

[Blonde Granny]

I received a phone call yesterday morning from a place called Pharmmd, and I let it go to voice mail. I listened to the message and was told they were calling for Humana. That's the company that has my Part D Medicare drug plan.

So, being the obedient one, I called the number back. I was told they wanted to set up and appt. for me with a Humana pharmacist to review my medications, and the interview and call would take 10-15 minutes. 10-15 minutes I would never get back in my lifetime.

So, I politely told the young lady that I wasn't interested.  I also told her that I knew Humana was quite upset with a med my cardiologist put me on, but I wasn't going to change it.  I've also been on mainly generic drugs for quite a few years, they work, so why on earth would I want to bug my PCP to change them.

I have also been getting this expensive cardio drug from the Drs. office.  They have seen fit to supply me with $4200.00 worth of samples to get me to the end of the year and out of the Part D donut hole.

[wvugurl26]

Part D is required by CMS to offer those services for certain beneficiaries. Medication therapy management is required if you have at least 3 chronic conditions (sponsor can set this at 2), are taking multiple Part D drugs and are likely to incur annual Part D drug costs over $3,017. Seems like you might meet all of those conditions. You can of course decline but CMS encourages plans to solicit beneficiaries quarterly and requires it annually. It's one of the areas they get audited on.

[Blonde Granny]

Really? This is the first time in 5 years I've ever been contacted. But Humana about blew a fuse when I was put on the blood thinner Eliquis...yes, that's the one with the stupid commercials. They have sent me letters and a couple of phone calls about there being a less expensive drug...warfarin.  Warfarin requires regular blood tests and there are dietary restrictions with it. It may be cheap but it's a nuisance.

I'm also in the donut hole till the end of the year. Thank goodness my Cardio double ordered my RXs so I have enough to last until next year.

[wvugurl26]

Aug 14, 2014 7:46:25 GMT -5 Blonde Granny said:

Really? This is the first time in 5 years I've ever been contacted. But Humana about blew a fuse when I was put on the blood thinner Eliquis...yes, that's the one with the stupid commercials. They have sent me letters and a couple of phone calls about there being a less expensive drug...warfarin.  Warfarin requires regular blood tests and there are dietary restrictions with it. It may be cheap but it's a nuisance.

I'm also in the donut hole till the end of the year. Thank goodness my Cardio double ordered my RXs so I have enough to last until next year.

It has been a requirement for a few years now. However, if most of your previous drug regimens were generic you might not have hit the spend component. And that's not to say that Humana was abiding by the rules either if you've had them for the past few years. Just because CMS makes it a requirement doesn't mean everyone complies. Audit findings in the past couple years have included plans making more restrictive requirements for MTM services and this reducing the number of eligible beneficiaries. They may have also just sent you a letter in the past or had the pharmacist ask you when you picked up prescriptions if you were eligible.

It's intended to help beneficiaries with multiple drugs. The ones that have drugs x, y and z to treat certain things then a few more to counteract side effects of drugs x, y, and z.

[Blonde Granny]

What is MTM services? That's a new one I've not seen before. Until Eliquis, all my maintenance drugs were generic. First time in the donut hole too.  Except for one (Xanax) unless it's due to sickness, they all go through the mail order company Rightsource.

Since Xanax is controlled it's easier to use Walmart.  I'm also going to ask the PCP this fall for 4 separate RXs that I can get at WMT 90days/$10 and not run it thru my insurance.

I sure don't know what elderly (OK, I'm almost 70, but not dumb yet) do when it comes to this stuff.

If I need to know anymore, c'mon lay it on me.

[wvugurl26]

MTM = Medication Therapy Management is the area under which the sponsors do comprehensive medication reviews (CMR). CMS wants CMRs done for the purpose of identifying drug interactions and making sure people really need all those drugs. Some do of course but there are concerns that some are taking things in combination that shouldn't be especially if they utilize multiple pharmacies.

Enrollment was changed to opt out at some point so that's why you got the phone call since your new blood thinner costs pushes you into the targeted population for MTM.

They proposed broadening the MTM rules for 2015 but backed down in the final rule. CMS estimates it takes 35 minutes to complete the CMR they offered you.

Bottom line of course you can decline. It's one of the things CMS is pushing and auditing for so don't be surprised if it comes up again next year even as early as January. You were enrolled as eligible this year and sponsors are encouraged to roll those people over to 2015 automatically and contact them in January.

[Blonde Granny]

That's interesting, thank you so much!! I plan on seeing if I can find a different plan next year that is more financially appropriate for the drugs I take. As I said, all are generic already except the Eliquis.

If I would have known all this yesterday, perhaps I would have been a little nicer about things....well, maybe not! I was busy blaming Humana & RightsourceRX for everything rather than CMS, as it all started when they filled that first RX for Eliquis. As it is now, I'm getting some help from my cardio office. Damn that stuff is expensive. And it tossed me into the hole and didn't tell me until I got a refill and about fell over with the price.

Again, thanks for your info, I appreciate it!!!

[wvugurl26]

Aug 14, 2014 10:47:07 GMT -5 Blonde Granny said:

That's interesting, thank you so much!! I plan on seeing if I can find a different plan next year that is more financially appropriate for the drugs I take. As I said, all are generic already except the Eliquis.

If I would have known all this yesterday, perhaps I would have been a little nicer about things....well, maybe not! I was busy blaming Humana & RightsourceRX for everything rather than CMS, as it all started when they filled that first RX for Eliquis. As it is now, I'm getting some help from my cardio office. Damn that stuff is expensive. And it tossed me into the hole and didn't tell me until I got a refill and about fell over with the price.

Again, thanks for your info, I appreciate it!!!

Unless you find a plan that has donut hole coverage Eliquis will continue to sink you in it. You get a 50% break on brand name drug costs in the donut hole. I imagine that could still be expensive. Eliquis could push you through the donut hole into catastrophic coverage though. Of course the problem with that is the big out of pocket costs to get there.

I think it is a good practice to use the plan finder during open enrollment. You plug in zip code and drug list and it lists out the options and your estimated costs. Plans can and do change from year to year which is why I recommend checking each year.

[Blonde Granny]

My cost went from $116/90 days to $877/90 days. Thank goodness my cardio staff is helpful. But, I have this annoying little heart problem and when I resisted taking it the Cardio simply asked me what I would prefer? a stroke or not taking it? I opted to take it. The drug is showing fewer side effects and better results than others on the market.

I've been a part of clinical trials twice now, so I opt for the better option.

[wvugurl26]

Aug 14, 2014 11:28:24 GMT -5 Blonde Granny said:

My cost went from $116/90 days to $877/90 days. Thank goodness my cardio staff is helpful. But, I have this annoying little heart problem and when I resisted taking it the Cardio simply asked me what I would prefer? a stroke or not taking it? I opted to take it. The drug is showing fewer side effects and better results than others on the market.

I've been a part of clinical trials twice now, so I opt for the better option.

The sad part is the true cost is $877 times two. The $877 represents a 50% donut hole discount on brand name drugs. I'm glad the cardiologist was able to get you samples.

[Rocky Mtn Saver]

  Man, you learn the most random but useful things on this board!  Thanks for the free education, ladies! 

[Blonde Granny]

I'm always amazed at the expertise our members have too. And grateful they are willing to share it with us!

[wvugurl26]

All that time I spend reviewing regulations has to be good for something!! Otherwise I've made my eyeballs bleed for no good reason. ;D

[TheOtherMe]

I have to be on the phone with my 90 year old father when we do this.  The company from which he retired provides them with counseling each year to get them enrolled in a Medicare Part D program.  For dad it's easy.  He takes no prescription drugs, so we go with the Walmart plan.

For mom, it was different.  She had lots of RXs.  She was going to go in to the donut hole in she had not passed away on May 19.  Once she went in to hospice care, all scrips she related to her terminal diagnosis were paid by Medicare.  So she would not have hit the donut hole.  I wish she had reached the donut hole.