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Any suggestions?

Medicare wants me to sign up for Medicare Part D to cover Sovaldi and Ribavirin.  But there are many many plans under Part D. Does anyone know which Medicare Part D plan covers these drugs? Any information is greatly appreciated. I am getting desperate.
Thanks!
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446474_tn?1404424777
"Does anyone know which Medicare Part D plan covers these drugs? "
Assuming you have original Medicare and need a plan to cover your meds, the plan you would want to chose is one that would cover any medicines you may be taking during the next year when you have the option to chose another plan.

Each Medicare Prescription Drug Plan (Part D) has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have different costs. So not only is being covered important, but what your co-payment will be. So prices may vary between plans that both cover Sovaldi.

A drug in a lower tier such as Tier 1 will cost you less than a drug in a higher tier. For example ribavirin is a generic drug and will be in the lower tiers whereas Sovaldi would be probably be in the top tier. So your co-payment would be higher for the Sovaldi.

For Example:
Cost Sharing Tier 1: Generic Drugs
Tier 1 is your lowest-cost Tier. Most generic drugs on the formulary are included in this Tier. Generic drugs contain the same active ingredients as brand drugs and are equally safe and effective. We have also included some preferred brands in this Tier.

Cost Sharing Tier 2: Preferred Brand Drugs
This is your middle-cost Tier, and includes preferred-brand drugs and some non-preferred generic drugs.

Cost Sharing Tier 3: Non-Preferred Brand Drugs
This is your higher-cost Tier and includes non-preferred brand drugs and some non-preferred generic drugs.

Cost Sharing Tier 4: Specialty Tier Drugs
The Specialty Tier is your highest-cost Tier among the Medicare formulary tiers. A Specialty Tier drug is a very high cost or unique prescription drug which may require special handling and/or close monitoring. Specialty drugs may be brand or generic.

To find plans available in your area go to the following link...
https://www.medicare.gov/find-a-plan/questions/home.aspx

To learn everything you wanted to know about Part D drug plans and how it works....
https://www.medicare.gov/Pubs/pdf/11109.pdf

I have the AARP MedicareRx Plan insured by UnitedHeathcare available here in San Francisco.

Good luck!
Hectors
7 Comments Post a Comment
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Avatar_f_tn
We live in NYS. My husband belongs to a Medicare Advantage Plan (Medicare Advantage Complete Choice) and he gets Extra Help for prescriptions after enrolling in the Medicare Savings Program (paid for by Medicaid). You may want to see if that is available in your state. His Sovaldi + Ribavirin treatment is being paid for in full by this program.

Best of luck to you.
Nan


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1815939_tn?1377995399
I have traditional Medicare (not Medicare Advantage). I get my prescriptions through my retirement plan so that would not apply to you. However, my cousin also has traditional Medicare and has their medi-gap insurance through Blue Cross Senior Gold. They get their prescriptions through Blue Cross too.

You have to see what is available in your state/area. Then compare the plans and look at the drug formulary for each company to be sure that they cover all of the drugs you needs. Going cheap is not necessarily going to save you money. Some premiums are cheap because they don't cover a lot of drugs and some are cheap because the co-pays are very high. So you have to really shop around to get the best insurance for you.

Have you tried calling your local Medicare office or your local senior center. Many of the local offices have some counselors available to help. My local senior center has a counselor that comes in once a week (or something like that) to help people figure this out.

Most plans have a list of drugs they may not cover. Most have several tiers of drugs, some that have low co-pays and some that have higher co-pays. Most make you pay more for brand name drugs than for generic drugs.

When choosing the company keep in mind that you want good coverage for whatever drugs you end up on. You may need the Sovaldi and Riba now, but you may need different drugs in 2 years, so it is good to choose a good plan that will cover you well in the future too.

In the end, be sure that whatever plan you choose covers what you need.

Best of luck.
Blank
446474_tn?1404424777
"Does anyone know which Medicare Part D plan covers these drugs? "
Assuming you have original Medicare and need a plan to cover your meds, the plan you would want to chose is one that would cover any medicines you may be taking during the next year when you have the option to chose another plan.

Each Medicare Prescription Drug Plan (Part D) has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have different costs. So not only is being covered important, but what your co-payment will be. So prices may vary between plans that both cover Sovaldi.

A drug in a lower tier such as Tier 1 will cost you less than a drug in a higher tier. For example ribavirin is a generic drug and will be in the lower tiers whereas Sovaldi would be probably be in the top tier. So your co-payment would be higher for the Sovaldi.

For Example:
Cost Sharing Tier 1: Generic Drugs
Tier 1 is your lowest-cost Tier. Most generic drugs on the formulary are included in this Tier. Generic drugs contain the same active ingredients as brand drugs and are equally safe and effective. We have also included some preferred brands in this Tier.

Cost Sharing Tier 2: Preferred Brand Drugs
This is your middle-cost Tier, and includes preferred-brand drugs and some non-preferred generic drugs.

Cost Sharing Tier 3: Non-Preferred Brand Drugs
This is your higher-cost Tier and includes non-preferred brand drugs and some non-preferred generic drugs.

Cost Sharing Tier 4: Specialty Tier Drugs
The Specialty Tier is your highest-cost Tier among the Medicare formulary tiers. A Specialty Tier drug is a very high cost or unique prescription drug which may require special handling and/or close monitoring. Specialty drugs may be brand or generic.

To find plans available in your area go to the following link...
https://www.medicare.gov/find-a-plan/questions/home.aspx

To learn everything you wanted to know about Part D drug plans and how it works....
https://www.medicare.gov/Pubs/pdf/11109.pdf

I have the AARP MedicareRx Plan insured by UnitedHeathcare available here in San Francisco.

Good luck!
Hectors
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Avatar_f_tn
I live in NJ and will be starting Medicare April 1st. Just got good news today that insurance through AARP (United Healthcare) is now covering Sovaldi and Olysio.  Just last week they did not cover these.  I would assume that maybe other AARP insurances through other states will also cover these.  The bottom line is you just have to keep plugging away and calling whoever you have to.  Things are changing all the time with regard to insurance coverages with these new drugs.  I called United Healthcare through AARP about 4 times and this was just for Part D Medicare.  Mainly, I had to keep calling back because I just plain did not understand their plans.  But now I'm glad I did and I actually do understand the plans

Good luck
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Avatar_f_tn
I have Express Scripts in Oregon. Last time I talked to them they said they would only cover Sovaldi with prior authorization. What all that entails I am not sure because I decided to wait on the newer Gilead tx.
Part D is a real pain when it comes to trying to untangle the mess unless you can afford to go with the more expensive Advantage plans.
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Avatar_f_tn
I have Medicare Part D with AARP which is United Healthcare. I just received the pre-approval last week for Sovaldi/Olysio combo. But they are Tier 5 drugs so my copay is still going to be a lot of money!
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Avatar_n_tn
Thanks to everyone who was so kind to take time to provide a response to my question.  The information has been extremely helpful.
I am now waiting for a response from the Part D plan I chose.
Thanks again from my heart to each of you for your responses.
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