I got a call yesterday from a client who was very upset about her Part D plan. She gets her medications by mail order and just received her first re-fill for 2013. She was upset that she paid $12 for one drug and $24 for another. Both these drugs are generics and the one-month supply co-pay is $4 for one and $8 for the other – so I couldn’t figure out why she was upset.
Then I realized her plan used to give her a deal for using mail order. The plan encouraged people to use their mail order by providing three months for the price of two. So last year my client would have paid $4 x 2, or $8, and $8 x 2, or $16. This year she’s paying $12 and $24. My memory is not very good, but I’m thinking she she might have paid $0 for her tier 1 generic when she used mail order.
Paying $12 and $24 for 90-day supplies might not seem like a big deal, but it reminded me that at least one Medicare Advantage plan made a major change to their mail order pricing for brand drugs for 2013. This Advantage plan used to have $45 co-pays for “preferred brand” drugs. But if people used the company’s mail order, they paid only $90 for a three-month supply rather than $135 at a pharmacy. This cost saving was a big reason for many people to be enrolled in that Advantage plan – but that changed for 2013. Now that savings is gone.
I have a feeling there will be many unhappy people as they refill their prescriptions for the first time in 2013. I have talked to a few clients who told me they were never told about these changes. I explained to them that they received an Annual Notice of Change from their Medicare Advantage plan, or Part D plan, at the end of September last year. This is a Medicare requirement.
“I’m sure I never received any such information”, is a statement I have heard from several clients. I don’t want to argue with them, so I don’t insist that they most certainly did receive materials from their plan. Of course, I’d bet about 10% of seniors actually read the Annual Notice of Change (ANOC). The ANOC is generally 30 pages or more and is not clearly labeled with something like, “YOU MUST READ THIS!”. On about the fifth page, there are two columns that clearly show changes from 2012 to 2013. Of course, a person has to get to page 5 to see this information.
Things can change in Part D plans from year-to-year.
**Certain drugs might be moved from one tier to another. I recently wrote about Lipitor being moved from “preferred brand” to non-preferred brand” with a price change from $45 to $90. Two years ago a Medicare Advantage plan moved Metoprolol Succinate ER from a tier 2 generic ($8 co-pay) to a preferred brand tier with a $40 co-pay. And these are just the changes I can remember.
**Mail order deals can be discontinued.
**Some drugs can be dropped from the plan formulary. This happens when there is more than one generic for a brand drug.
**The plan premium can go up (a little or a lot). Last year, a stand-alone Part D plan went from a $32 premium in 2011 to $72 in 2012.
All of this information is in the Annual Notice of Change (ANOC). But if people don’t read the ANOC, and they don’t realize they need to change their plan, they are in for a shock in the new year. And there is nothing they can do because they are stuck in their Advantage plan or stand-alone Part D plan for the rest of the year.