Sunday, November 11, 2012

Prescription Drug Coverage 2013

I am sorry I have not been able to write much this year and the deadline for making your decisions is only a few days away.  Hurricane Sandy visited Westchester, New York and turned a forest into a meadow.  Happily, not so much changed from last year so most of what I wrote applies. 

I just took a quick look at the rules that are being "upgraded" for the IBM's prescription drug plans.  The sentence saying that more than 250 drugs will require prior authorization in 2013 was not great to see.  What the provider will likely do is ask you to try alternate comparable drugs before they approve your prescription.  It is called step therapy.  That can range from annoying to life threatening as sometimes those alternate drugs don't work at all and can impact your health.

Once again, I decided to go with Aetna Integration A which meant I cannot use IBM's drug plan and had to select a separate private prescription drug plan (PDP) from a non-IBM provider.  I used the plan finder on the website to be sure I picked a PDP that has been sanctioned by medicare.  I also enrolled directly through the site as it is the quickest way to enroll and I have a record of the enrollment in case the private insurer makes a mistake and denies I was enrolled. 

The list of PDP providers available in your zip code can be daunting.  There are a lot of factors to consider when selecting a drug insurance plan such as -  where you will be able to fill prescriptions, whether or not step therapy will be required for your particular drug, deductibles (which cannot be higher than $350) and copays. Some plans also provide insurance in the "donut hole" but of course the premium for those policies will be higher.  All of these factors are important to consider when you pick a plan - not just premium price. 

My personal experience: this past year is the PDP plan I picked was cheap but it was not the best decision.  I could not use mail order and had to go to Target to pay the least for my prescription. However, they let me do 90 day refills so it wasn't too bad. The plan then decided not to cover my drug in 2013 so in September they stopped allowing 90 day supply refills.  I now have to go back to the pharmacy every month to get a refill.  It is annoying.   They also did not directly tell me the drug would not be covered in 2013.  They just said there were changes in their formulary and I should check their formulary. 


1 comment:

  1. My friend was just telling me about getting medicare insurance. Apparently it's a pretty nice option. My friend just had a baby and I think they should have gotten it.