Drug Information

The New Medicare Plan Finder Doesn’t Make Finding Your Best Drug Coverage Easy

Needle.

As of October 1, 2019, the new Medicare Plan Finder will be the only source of information about Part D and Medicare Advantage plans. This is 14 days before the very important Open Enrollment Period begins. Those who help enrollees and beneficiaries review their coverage and select plans are getting very nervous about being able to do their job. There are two reasons for that.

  1. In order to save information, one must have a MyMedicare.gov account. Setting up an account requires one to enter a Medicare number, which will present a challenge for those who help beneficiaries with drug plan review.  Those without a Medicare number will have no way to save their data. They will likely have to enter their drugs and other information more than once as they search through plans.
  2. Just as important, the new Plan Finder has eliminated some important features that are essential to finding the best and most cost-effective plan, the most fundamental purpose of this tool.

Here are some of the features that cannot be found in the new Plan Finder.

•    Preferred pharmacies:Officially called pharmacies that offer preferred retail cost-sharing, plan members can save money by using them. The copayment or coinsurance can be less simply because this pharmacy has agreed to charge less for plan members. Not every plan offers this extra benefit.

In the current or Legacy Plan Finder, there are two ways to identify these pharmacies.

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  1. Toward the bottom of the side-by-side comparison, there’s a section, “Pharmacy Network,” with a link identifying the number of network pharmacies in your zip code. Click on that and you’ll see a chart of all the pharmacies and their status (preferred or standard retail cost sharing or out-of-network.)
  2. Click on “View Drug Cost Summary” on the comparison page. This leads to a comparison of out-of-pocket costs at each of the selected pharmacies. A top line identifies whether the pharmacy offers standard or preferred cost sharing or is out-of-network.

The new Plan Finder does not include either of these features for identifying a pharmacy’s status. When asked during the Medicare Plan Finder webinar on August 16 about how to identify preferred pharmacies, the presenter suggested that the user change pharmacies and then compare the costs. Besides being inefficient, that may or may not identify preferred pharmacies, depending on the current drug regimen.

•    Drug Benefit Summary: It’s possible not many know about this very useful tool. The link is on the Overview page of the Legacy Plan Finder. Click it and you’ll find information about the plan’s cost sharing information.

Why is this so valuable? It provides details about costs for different pharmacies, including tier name and the copayment or coinsurance for 30-, 60- and 90-day retail or mail order supplies at preferred or standard cost sharing pharmacies.

Sue takes one Tier 3 medication. One plan charges 21% and a second, $40. The full cost of her medication is about $300. She would pay $63 in the first plan and a flat $40 in the second. 

Also, when a plan charges a coinsurance, a plan member can pay more as the price of the drug increases.

It does not appear that the new Plan Finder includes this cost sharing information.

•    Total drug costs for the year: One of the most important factors affecting a decision is the total cost, including monthly premiums and costs for prescriptions. Paying a higher premium can save on total drug costs but then again, maybe not.

The legacy Plan Finder has an “Estimate of What YOU Will Pay for Drug Plan Premium and Drug Costs,“ the total out-of-pocket cost to the beneficiary.

The side-by-side comparison in the new Plan Finder notes estimated yearly costs at retail or mail order pharmacies. These numbers do not include the premium. To get total costs, you would have to multiply the premium by 12 and add that to the numbers in the comparison. Doable, but why? The Legacy Plan Finder does it for us. (There have been reports recently that the Centers for Medicare and Medicaid Services knows about this flaw and is working to fix it by the end of September.)

In a press release on August 27, the CMS noted, “It’s now easier to compare coverage options and shop for Medicare health and drug plans.” Eliminating some of the most helpful features from the Legacy Plan Finder means beneficiaries won’t be getting a complete picture and they could pay more. And, it certainly won’t make the process easier.

[“source=forbes”]