Question on PDP Tier Copays for 2024

[Duaine]

Ok, so we have some PDP's with percents of "retail" costs on Tiers 3 & 4 for 2024. With the all of the various monies flowing to pay the drug costs such as manufacturer discounts etc how will we really be able to tell our clients what they will be paying out of their pockets each month for those drugs?

 

[somarco]

Percentages (vs dollar amount copay's) offer "protection" for the issuing carrier and none for the insured.

If someone asks "How much will this cost?" the only thing I can offer is "You will only pay 25% of the cost, the remaining 75% is paid by the carrier". They rarely press me for more info.

The drug report generated by S&S illustrates a dollar amount for budgeting purposes.

 

[Truce]

1) Work with a CRM that saves every drug list you run and show people. Just in case.

2) Warn them that prices can and will change.

3) Remind them that it is irritating to drug manufacturers when consumers know and care how much drugs cost at the point of sale. Staring in 2025 your annual Part D drug costs will be projected out for the year and divided by 12 and paid direct to the Part D carrier, capped at $167 month. Everything will be bliss after that.

 

[Chazm]

I never tell someone how much they will pay for a medication when it’s a %.

 

[Midlevel]

I never tell someone how much they will pay for a medication when it’s a %.

That's for sure, prices haven't even been close to being right for years.

 

[somarco]

I give them the S&S report and tell them this is an ESTIMATE of what your costs may look like. Anything more is digging your grave.

All my clients have plan G + OM but I don't even tell them your OOP for health care won't exceed the Part B deductible.

 

[Midlevel]

I give them the S&S report and tell them this is an ESTIMATE of what your costs may look like. Anything more is digging your grave.

All my clients have plan G + OM but I don't even tell them your OOP for health care won't exceed the Part B deductible.

Good idea, because about that time they will get a 26.00 bill for prescriptions during hospital stay and come whining but you said…..

 

[sshafran]

how will we really be able to tell our clients what they will be paying out of their pockets each month for those drugs?

This has never been within the scope of our job.

We (1) explain the summary of benefits and (2) help with finding tier levels