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Oct 1, 2018 07:26AM
Oct 1, 2018 08:00AM
I read that Consumer Reports article. It applies to drugstores' own discount programs for commonly used generics--NOT manufacturer co-pay cards or discount coupons for their brand-name drugs. Granted, I was, as a Costco member, able to buy generic topical diclofenac gel, albeit not quite as cheaply as I've paid in Europe for Novartis' Voltaren gel (over-the-counter in the EU!) when Humana wouldn't cover either the generic or Voltaren. But the other "secret" for savings? Income-related mfr. & gov't prescription assistance programs. (If you are wondering if you're eligible for those, probably not--if you have to ask, your income is too high).
Only GoodRX coupons are legal for "bypass-your-insurance" out-of-pocket. No way you can legally use a mfr. discount coupon if you are on Medicare, even if you pay 100% "under the table" out of your own pocket and leave Medicare out of the picture. The fine print on the coupons (and at the bottom of the screen in the TV commercials for those insanely expensive biologicals for not just metastatic cancers but also autoimmune diseases) say that they are not valid for patients on Medicare, Medicaid or Federally-subsidized insurance (e.g., Tricare, Fed. employee ins, plans)--even if you leave Medicare et al out of it. Not simply that they can't be used with Medicare, etc.
The manufacturers can afford to give deep discounts (or even free meds) with these coupons or cards because insurance companies reimburse them (and pharmacies & benefit managers). But Medicare supplement carriers don't reimburse pharma companies or pharmacies--it's a condition of those carriers being allowed to participate and be subsidized by the CMS. I'm not sure, but if caught you could lose your Part D benefits, pay a civil penalty or even be fined. (Haven't dug through the Federal statutes to see if it's actually a crime or "just" a civil violation). Pretty sure I read that in either my Medicare handbook or the annual Humana Part D manual.
Yes, you can always go out-of-pocket for any prescription drug you can afford. But bear in mind that even if the cost doesn't count towards dropping you into the donut hole, once you're already in there, it doesn't count towards pulling you back out into catastrophic coverage, either. (Nasty little gotcha about Part D: the "magic number" that kicks you into the donut hole includes how much your Part D insurer pays, not just your co-pay; but to climb back out, only your out-of-pocket--for purchases made via your Part D plan--costs count. So if, say, you & InHumana have shelled out >$3750 combined,even if your share was a mere fraction of that, welcome to the donut hole. But no matter how much InHumana pays for drugs you buy while you're in the hole, it's only what you pay via your coverage that counts towards meeting the $5000 threshold for getting back out--and what you pay "under the table" doesn't count. For branded drugs, the donut hole goes away in 2019. But it's still there for generics (albeit your share for generics will be 37% instead of the 44% you currently pay while in the 2018 donut hole).
Diagnosed at 64 on routine annual mammo, no lump. OncotypeDX 16. I cried because I had no shoes...but then again, I won’t get blisters....
9/9/2015, IDC, Right, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC)
9/23/2015 Lumpectomy: Right
11/2/2015 3DCRT: Breast
12/31/2015 Femara (letrozole)