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Social Security & Medicare - I am not happy with my drug plan.
Q: I am not happy with my drug plan. First, I had no choice but to enroll with the Medicare plan that I already had under threat of losing my other supplemental health benefits if I chose some other insurer’s drug plan. I used to get my drugs, Toprol and Lipitor, for $21.00 a month through the Together Rx & Share cards, provided by the drug companies. Now under my Part "D" plan I have to pay $99.00 a month for the same drugs. Therefore I have stopped taking Lipitor, and am looking for a generic version of metoprolol instead. Why can’t I use my drug discount card from the drug manufacturers? - C. S., Brodheadsville,Pa. A: Don’t give up your drug discount cards just yet. Changes in Medicare’s guidelines for drug plans suggest that you may be able to take advantage of them. Not only would this help you delay hitting the gap in coverage, it would be especially helpful during the deductible, and if you do hit the doughnut hole coverage gap, when most beneficiaries generally must pay 100% of the cost. From the little we have learned so far, however, don’t count on help from Medicare or your drug plan. The rules say that if you are able to receive a better cash price through a "network" pharmacy for a covered drug, than the normal price your plan offers, you may purchase that drug at the discount price. Your purchase price for the discounted drug will count toward the $3,600 total out-of-pocket you must spend to reach the catastrophic level of coverage. Because you will not use your regular Part D drug plan card, however, you must send the receipt, and a letter requesting that the purchase be counted as part of your out-of-pocket spending to your drug plan for every purchase you make. Peter Ashkenaz, a spokesman for the Centers for Medicare and Medicaid, confirmed that drug plans have received the guidelines, and that the rules are currently in effect. It’s very likely, however, that you may face big challenges in trying to take advantage of these new rules. According to a survey by the Government Accountability Office, Part D drug plan call centers in general gave inaccurate or incomplete answers in two out of three questions asked. In addition, few Medicare advocates have received information about these rules yet. You should be highly cautious when trying to clear this through your drug plan. Should your drug plan be unfamiliar with the new rules, or if you don’t follow procedures correctly, your drug plan might turn down your request to count your discounted purchases toward the $3,600 in out-of-pocket costs. Right or wrong, it would take you longer to reach catastrophic level of coverage, and it could be difficult to correct errors. Hopefully this new rule change will become better known in the coming months. In the meantime you might be better off just switching to generics. The generic metoprolol is available. In addition, you might want to ask your doctor if a new generic of Zocor would be a suitable alternative to your Lipitor. October 2006 | ||||||||
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