Specialty meds...

[kpbdy99]

So, I finally decide to pull the trigger on MedSupps, and the first prospect I meet with has used, in the past, a specialty cancer med that's not on any formulary, anywhere, either on a PDP plan or an MA-PDP plan. He's concerned he may need to use it again, and it costs several thousand $ per month. What's next?

 

[Chazm]

If he’s a prospect and not a client, my first goal is to see if you can even switch him to a new med supp. If you can’t then move on. No need to worry about his drug plan.

If he is a current client and is concerned about getting this med, he’s pretty much out of luck if it’s not currently covered by his plan. The enrollment period ended 12/7.

If he is a T65 and currently on a group plan then you might need to ask him if he can keep his group plan. How much is it? How is his coverage?


There’s too many variables going on here that you aren’t giving us. Is this medication administered at the doctors office? Drug store? Etc etc etc

 

[somarco]

What is the name of the drug and dosage? Is it self administered? What was the condition treated and why does he think he might need the drug again?

 

[GreenSky]

What is the name of the drug and dosage? Is it self administered? What was the condition treated and why does he think he might need the drug again?

For a guy from New Jersey, you sure ask a lot of questions.

Rick

 

[DS4]

It could be the Rx is covered under Medicare Part B. What is the name of the Rx?

 

[kgmom219]

Go to medicare.gov and search Part B medication. There's a list.

Assuming it IS Part B, there's already some hesitation from the client. Send him the link to the Part B list and also back to the oncologist. "While I am 99.9% sure there won't be a problem, I recommend calling your oncologist for confirmation".

Helpful hint: if you can't find the drug on a PDP plan, there's a reason. Start at Medicare.gov for the Part B meds. And google the name of the drug and medicare.

 

[bekahsack]

So, I finally decide to pull the trigger on MedSupps, and the first prospect I meet with has used, in the past, a specialty cancer med that's not on any formulary, anywhere, either on a PDP plan or an MA-PDP plan. He's concerned he may need to use it again, and it costs several thousand $ per month. What's next?

Does he currently have cancer, or is he worried about a relapse?

 

[David Taylor Jr]

You can also use sites like RxAssist - Patient Assistance Programs to see if there are assistance programs for that specific drug available.