Changes to Part D plans come in different forms: a higher monthly premium; drugs being dropped from coverage; brand drugs being moved to a higher tier with a much higher co-pay.
This weekend I was checking on Part D plans for the husband of one of my clients. He takes Exforge, and I discovered that not all plans cover this drug. I emailed my client, the wife, to inform her that the Part D plan she has does not cover Exforge. Rather than email me, she called me up to say that she takes Exforge and it is covered by her plan. Hmmm…
Note: Because I am an insurance broker, I am not allowed to name names, lest someone think I am promoting a plan or plans.
I used the Medicare.gov Plan Finder to look at 2012 coverage, so I went back and looked at information for 2011… and I saw that Exforge is covered this year by my client’s plan. Then I went to the website for her Part D plan and typed in Exforge to see if it is covered for 2012. I found that it is not covered in 2012. Just to be sure, I called the 800 number on the website and talked to a company representative who told me that Exforge is covered this year but not next year.
My client was surprised to learn about this important change in her plan, one of the most popular Part D plans (in terms of enrollment). I don’t know if she was informed of this change. It might have been included in the materials all Part D and Medicare Advantage plans are required to send to each enrollee in September. Most people do not read the Annual Notice of Change that informs them of changes for the coming year. So we stumbled onto very important information that will require my client to switch to another Part D plan so she can continue to take Exforge.
11/13/11 UPATE: I was looking for information on the AARP Medicare Rx Part d plan, I found the following information on one one of their web pages. It tells me that everyone does get information about changes to their plans – if they read it.
2012 Formulary Changes
If you’re a continuing member in the plan, you’ll receive an Annual Notice of Changes (ANOC). You may notice that a formulary medication you are currently taking is either not on the upcoming year’s formulary or its cost-sharing or coverage is limited in the upcoming year. If your drug has been removed from the formulary or has a new requirement and limit that you must follow, the plan will send you a separate communication to notify you.
CHANGES I’VE DISCOVERED
I’ve already written about the Part D plan that is going from $33 per month to $71.
One Medicare Advantage plan is moving Lipitor from tier 2 to tier 3 with a $95 co-pay. It has always been a tier 2 drug with a $42 co-pay. Lipitor is going generic later this year, so that may be why the company is raising the co-pay for this drug.
The lesson here is that your Part D plan, whether it is a stand-alone plan or part of a Medicare Advantage plan, might be changing. And you need to be sure your brand drugs are still covered, or are not going to double in price. And I’m not sure anybody needs to pay $71 for a Part D plan that doesn’t even cover all drugs.
WHAT TO DO
For people who are comfortable with the internet, this information can be found on-line – though some company websites are easy to navigate while others are pretty challenging. If you are not computer savvy, you can call the phone number for customer service/member services on the back of your Part D or Medicare Advantage id card. Ask the customer service rep to tell you what your co-pay will be for your brand drugs in 2012.
Remember: If you snooze you lose. Don’t wait to discover these changes in January when it will be too late to change your Part D plan or your Medicare Advantage plan. You can fill out the forms to change your plan up until December 7th. Your new plan would take effect on January 1.
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