By Andrew Johnson and Justin Fundalinski, MBA | October 20, 2016

Medicare Part D

With autumn upon us it is rather easy to see and feel the changes of a new season: the air gets crisper, the days get shorter, leaves change colors and baseball gives way to football. Unfortunately, Medicare Prescription Part D Plans are subject to change soon too.

Some Medicare changes we can set the clock to, such as the annual reset for deductibles and the coverage gap known as the “doughnut hole”. However other changes, such as changes in what prescription drugs are covered, are not as obvious as the start of Monday Night Football. When it comes to prescription drug coverage, Medicare may move the goal line on you by not continuing to cover some of your medications. This month, we’d like to look at some reasons why you may need to review your Prescription Part D Plan playbook and discuss some basic steps to avoid overpaying for your prescriptions.

Changes within your personal situation:

Reviewing your Prescription Drug/Part D Plan (PDP) can be particularly important if, in the last year:

  • You had a change in your prescription drug use.
  • You moved or changed your primary legal residence.
  • Your carrier altered or discontinued your plan from the previous year.
  • You were unhappy with paying more than you may have had to for the prescriptions you use.

Changes within your prescription plan:

Even if your personal situation has not changed, the formulary (the drugs covered by your prescription drug plan) can change right out from under you.  To make things more complex (because it is so simple already), depending on when the prescription drug plan changes, the drug plan provider can notify you in different ways.

  • If changes are made during your coverage year, the insurance company is required to identify specific drug changes that impact you personally. They give you a 60-day notice that the changes are happening and you will typically be able get a 30 day supply of your current prescription drugs within 60 days of the change taking place to help you transition over to different prescriptions covered under the new formulary. It’s nice that the insurance provider lets you know of the changes so you can make prescription changes… too bad it does not allow for special enrollment period so you can shop around for a new plan.
  • If the changes are made on the upcoming year of coverage (when your plan renews for an additional year) you can throw out those courtesies of the insurer letting you know that changes will impact you personally. Yes, you will receive an Annual Notice of Change (ANOC) letter in September, but this letter will not outline if a drug you are currently using is removed, re-tiered to be more costly, or has an increase to its copay. It is up to you to review that the coverage of the drugs you will use has not changed for the coming year, and unless you read/analyze your ANOC carefully each year, you may experience some negative impacts.

The best ways to avoid overpaying:

Since the plans offered and the drugs covered change from year to year along with your health and personal situation, reviewing your plan each year can save you money.  Avoid making a costly mistake by following these simple tips:

  • Don’t assume that you are already in the best available plan for your needs.
  • Compile a comprehensive list of your prescriptions; their dosage, as well as how often and where you fill them.
  • Visit to compare different plans that are available to you. You can use the “Find Health & Drug Plans” tab on their website and search using your zip code to find plans and local or mail-order pharmacies.
  • Don’t focus on premium alone. Deductibles and increased copays on your select drugs can outpace the monthly savings on premium.

There are typically a few dozen plans available and based on your prescription needs you may be overpaying for the same drugs bought from the same pharmacy solely because of the plan you selected.  Every year the plans get the chance to move the goal line on you, and you have between Oct 15th and Dec 7th to check your playbook and confirm that you are still in the best plan that meets your needs prior to getting locked into it for another year. If you feel like Medicare moved the goal line for you and want some help with your playbook, please feel free to reach out to the office and schedule a time to meet with Andrew.