7 Things to Watch Out for in New MAPD and PDP Plans

[Brian Anderson]

NAMSA President Ron Iverson has just shared some key observations from NAMSA members in the field that may be helpful for agents selling or servicing these plans.

You can find the short new article at the link below, and please share how the issues he mentions align with what you are experiencing, or any other “head’s up” items agents should be aware of this enrollment period.

Insurance Forums | 7 things to watch out for in new MAPD and PDP plans

 

[kgmom219]

Well.

This is all true. But its true every year.

 

[bluediamond]

Nothing to add here, the same year after year.

 

[Bob_The_Insurance_Guy]

Never heard of this organization; however, if this guy speaks for them, their standards are pretty low.

Not only is this guy dated in his information, but he is also inaccurate on a few points. You would think that someone who leads an organization would be better versed. Just a few sticking points.

More and more prescription drugs no longer in formulary:Nothing could be further from the truth. I have had several clients who were prescribed medication that was not in the formulary. A simple call from the physician to the insurance company solved that problem. And as for the cost of medications increasing, that is also inaccurate. Between now and 2020, the donut hole will become smaller and smaller.

Plans being dropped in the area:Again, a bit of inaccuracy, compared on where you live. Here in the Atlanta market, United healthcare pulled out some plans, but Piedmont Wellstar, Cigna, and Humana were there to catch the orphans.

Other than that, the article was right on point. My fear is that the end-user, the Medicare beneficiary, will read this. And actually believe it.

 

[sman]

Never heard of this organization; however, if this guy speaks for them, their standards are pretty low.

Not only is this guy dated in his information, but he is also inaccurate on a few points. You would think that someone who leads an organization would be better versed. Just a few sticking points.

More and more prescription drugs no longer in formulary:Nothing could be further from the truth. I have had several clients who were prescribed medication that was not in the formulary. A simple call from the physician to the insurance company solved that problem. And as for the cost of medications increasing, that is also inaccurate. Between now and 2020, the donut hole will become smaller and smaller.

Plans being dropped in the area:Again, a bit of inaccuracy, compared on where you live. Here in the Atlanta market, United healthcare pulled out some plans, but Piedmont Wellstar, Cigna, and Humana were there to catch the orphans.

Other than that, the article was right on point. My fear is that the end-user, the Medicare beneficiary, will read this. And actually believe it.

While the article is nothing new as has been stated by other posters, I don't recall the article stating "more and more prescription drugs no longer in formulary". What I did read was, "Some expensive drugs quietly removed from new formularies" which is true every year. I have several clients whose plans in 2014 cover a particular medication which will no longer be covered in 2015. Again, this is nothing new.

And as for the cost of medications increasing, I read that to mean the retail price of medications are increasing (not necessarily the copays a member pays). Here is the wording from the article:

Beware of skyrocketing drug prices. It is entirely possible for a client with an expensive drug need to blow right through the deductible, the co-pay/co-insurance, the donut hole and into catastrophic coverage with the first month’s prescription. Drug prices, even for some old generics, have skyrocketed during the past year

Again, that isn't an untrue statement. Reaching the donut hole and catastrophic phase are based on the retail price of the medication and not what the member pays. In just doing a quick search of some old prescription plan comparisons from 2008 to now, I can point to one anecdotal piece of evidence to back up this statement. For a particular client in 2008, the prescription plan comparison from 2008 shows the retail price of a one month supply of 200mg Celebrex to be $102.84. On a comparison for the 2015 plan year, it shows a retail price of $212.14 on one plan and $244.13 on another. This is just one example, but it plays out on many medications. While the copay for the member may not have changed much over the years, that doesn't change the fact that the retail price of Celebrex (and other medications) has increased over the years.

 

[Bob_The_Insurance_Guy]

How many people go through the Donut Hole, and into the Catastrophic area? Give me a percentage.

I have a client that takes Humira. By March, she is in the Catastrophic area, and pays 5% for the rest of the year.

I got that.

Touch on more plans leaving. Was I incorrect on that point?

 

[sman]

How many people go through the Donut Hole, and into the Catastrophic area? Give me a percentage.

I have a client that takes Humira. By March, she is in the Catastrophic area, and pays 5% for the rest of the year.

I got that.

Touch on more plans leaving. Was I incorrect on that point?

What does it matter how many go into the donut hole and the catastrophic phase? That wasn't the point being made. The point made was that the costs of prescriptions are increasing which can cause people to hit the donut hole. This is what you said regarding costs:

And as for the cost of medications increasing, that is also inaccurate.

I gave a very real example of how costs are increasing. I just looked up another one. A one month supply of Zetia on a 2008 comparison showed a retail price of $85.80. On a 2015 comparison it shows a retail price of $192.58. I can't help you if you can't understand the point being made here. It's almost as if you're trying to find something to complain about. What you are saying the article said isn't what it said.

Lastly, to "touch on" your comment about "more plans leaving". That isn't what the article said. What it said was:

Withdrawn plans. Some of the plans may have completely withdrawn from certain counties—thereby leaving the client with no choice but to find another plan.

What is inaccurate about that particular comment? Do plans get withdrawn from time to time? Yes, they do. Do new plans come in? Yes, of course. Here in the greater metro area I can name a few just real quick off the top of my head. The Medicare Preferred Core PPO plan from BCBS that was withdrawn from multiple counties. Or how about the Smart Value Plus plan they had before that? Coventry has had plans that are no longer available. Certain parts of Cobb County have two fewer plans in 2015 than in 2014. Gwinnett County has two fewer plans in 2015 than 2014 (and I'm speaking specifically of non-SNP plans). Fulton County has 4 fewer plans in 2015 than 2014. Shall I go on?

The article made a point about plans being withdrawn. That isn't inaccurate. It happens. For some reason you are interpreting the article to say something it isn't saying and appear to be getting upset about it. For what reason, I have no idea.

 

[somarco]

I recall seeing somewhere that only 6% of retirees hit the donut hole. In the grand scheme of things, that's not many .............. unless you are in the 6%.

And closing the donut hole comes at a price.

Higher premiums, higher Rx deductibles, higher copay's and tier shifting will "eliminate" the donut hole by redistributing the cost. Something a Socialist would have promoted as being "the right thing to do"

 

[sman]

And closing the donut hole comes at a price.

Higher premiums, higher Rx deductibles, higher copay's and tier shifting will "eliminate" the donut hole by redistributing the cost.

That's exactly right Bob. Politicians touting the elimination of the donut hole aren't telling the other side of the story. Insurance companies aren't going to just eat those costs. They will be passed along to the consumer.

I also firmly believe that drug manufacturer's have taken advantage of Part D. There's no reason for the costs of medications to increase as substantially as they have over the last decade. They saw a way to get some easy money and did it. Either that or pharmacies jacked their prices up to make a quick buck.

 

[jwk1257]

There is one thing producers need to do - and that is check the annual change of benefits.....I had a client call me and tell me the Care Improvement Plus was now charging a premium AND a drug deductible.....It is nice to know these things so you can inform your client, because some of them don't read them, and if they are not aware of the change - you will be getting a LOT of calls to handle!!!