Wrong Prices Charged by Pharmacy

[beachbum2012]

I'm sure it happens a lot more than I hear about it, but every once in a while I'll get a call from one of my clients saying the pharmacy charged them more for their copays than what it shows they should've paid in the Medicare Plan Finder on Medicare.gov. Assuming the prices in the Plan Finder are correct, would the PDP insurance company ever reimburse my client (or at least credit their account) for the difference? How have you all handled situations like this in the past?

 

[wehotex]

I'm sure it happens a lot more than I hear about it, but every once in a while I'll get a call from one of my clients saying the pharmacy charged them more for their copays than what it shows they should've paid in the Medicare Plan Finder on Medicare.gov. Assuming the prices in the Plan Finder are correct, would the PDP insurance company ever reimburse my client (or at least credit their account) for the difference? How have you all handled situations like this in the past?

You should do a 3-way call to the PDP co and get some details. You might also want to provide some alternatives to the Rx, if it's pricey. Show them that you empathize with them and will do your best to resolve the issue. If it's an ongoing issue, plan a time to call them back.

 

[somarco]

shows they should've paid in the Medicare Plan Finder on Medicare.gov.

That's your first problem.

Check pricing on the carrier site, not Mcare.gov.

 

[DS4]

The PBM report their pricing to Medicare. The Medicare Formulary Finder reflects these reported prices. If a pharmacy is charging a considerable difference, a complaint to Medicare needs to be filed.

 

[insuranceconceptscindy]

I tell my clients that the report I give them, from Medicare.gov, is a GUIDE- it's not ever going to be 100% accurate. For the most part, the copays match up, but the retail prices are usually off by a few cents or maybe a few dollars. If it is dramatically different- should be $25 and they charge $125, phone calls need to be made. I haven't come across any huge discrepancies without a simple explanation- ie: a drug they didn't tell me about not covered.

 

[yogooglethis]

I'm sure it happens a lot more than I hear about it, but every once in a while I'll get a call from one of my clients saying the pharmacy charged them more for their copays than what it shows they should've paid in the Medicare Plan Finder on Medicare.gov. Assuming the prices in the Plan Finder are correct, would the PDP insurance company ever reimburse my client (or at least credit their account) for the difference? How have you all handled situations like this in the past?

Make sure that particular pharmacy location is in network.Some carriers like UHC have Walmart,CVS etc. chains in network by and large but not every single location of these pharmacy chains are in network.Had this happen a couple of days ago

 

[EltonHCP]

... I'll get a call from one of my clients saying the pharmacy charged them more for their copays than what it shows they should've paid in the Medicare Plan Finder on Medicare.gov. ...

Is your client in the deductible phase or the coverage gap? The PBM charges more than the copay during those benefit phases.