Monday, January 9, 2017

A Silver Pain in the Ass

Monday, 5pm. Mrs. Silver calls and tells me she needs me to answer a few questions about what Medicare plan she wants to get in 2017. I tell her that I am really no help in that area. I tell her that my training is in pharmacy, not billing. She tells me that since I work in pharmacy I should know all about it. Besides, she's been such a "good customer" all these years that we owe it to her.

I tell her that if she wants to call back and talk to Mickey about it that maybe he can help her. I tell her that he's on Tuesday but not to call until after 7pm because he'll be busy all day and after 7pm it slows down.

Thursday, 11am. I'm busy. Mrs. Silver calls and tells me she wants to ask me questions about what Medicare plan she should get. I tell her again that I'm really not someone to talk to about that. She says she knows I told her to talk to Mickey but she thought if she could just find out what our cash price is for various medications that could help her. She further wants to know if we have a discount like Good Rx. I tell her we have an in-house discount plan that is better than Good Rx in most cases.

And of course now she wants to know what her medications will cost on the discount. I tell her that without active prescriptions I can't tell her the price of the medications after the discount but I offer to give her the 800 number to the discount plan where she can call and find out exactly what they will cost at Goofmart. She declines to take the number.

Thursday, 6pm. It is not 7pm. It's still quite busy. And I'm not Mickey. Here comes Mrs. Silver with a friend who is introduced as having worked as a drug rep. Hearing this I immediately explain that since she's a former drug rep that her of all people should know that I don't have access to various Medicare plans and the specifics of each plan. "Oh no," she says. "YOU of all people should know." Was I not clear on the phone? I think to myself. But I was. I was crystal clear.

I tell them once again that I'm NOT the person to talk to about this. Mrs. Silver produces a prescription and if I could just tell her what the price of it would be on our discount card that would be enough for her. So I run the prescription on our in-house discount card and show her the amount. Then they want to argue with me that they can use the discount card on top of any Medicare plan. I tell them no, it doesn't work that way.

They leave, but I think I haven't heard the last of Mrs. Silver. But perhaps I'll get lucky and die before that.


Anonymous said...

I feel really bad for Mrs. Silver here. She is probably looking at a plan that says you will pay 20% towards medication in category A, 30% for category B, 50% for category C. She has no idea what her medications cost and no idea what category they fall into so she can't figure out what she would have to pay. She calls the insurance company and they say that since she's not yet a member of their plan they can't help her. Even if she were a member, they can't tell her what prescriptions cost because every pharmacy charges a different amount. So then she goes to the pharmacist. I understand that it is not your fault if your employer has the system set up so that you can't see cash prices without a prescription but that is an absurd system that really should be changed. People need to be able to shop around and the co-insurance plans are designed just for that. It incentivizes patients to go to the cheapest pharmacy.

Mrs. Silver is wrong about using the discount card AND Medicare, agreed. The rest though, I think should warrant some patience. At least she has the cognitive ability to try to do the research.

Anonymous said...

Assuming Mrs Silver is looking for info on drug costs through various standalone Part D plans MA-PD plans (and not through an employer-group), she already has access to all of the pricing and drug coverage info she needs through and 800-Medicare. Estimated prices for covered drugs through any plan at any pharmacy are available and updated with high frequency to reflect any changes. CMS holds plans to extremely high requirements regarding the accuracy of this pricing data.

Even if Mrs Silver was already aware a plan she was looking at had a coinsurance design but still needed actual dollar figures, those estimated costs are widely available for plans directly through and each plan's customer service.

The one reason not to direct to for help would be if she was known to have or be staying in employer-based Medicare coverage. She might only have general price structure information if she happened to be covered through an employer group which received a waiver of standard open enrollment requirements (such as making available specific pricing before enrollment), but if she has an existing Rx, she has filled before and knows or should know the full cost from that prior fill and can apply the coinsurance rate to develop an estimate.

What Mrs Silver wanted is not rocket science, and the pharmacy is really not the appropriate place to get the desired info. You wouldn't ask doctor's office for cost of a chest x-ray under all Medicare Advantage plans offered in your area, would you? Really, the only appropriate question for the pharmacy for Mrs Silver's issue would be "Crazy, may I have a printout of my prescriptions?", and assuming she currently fills everything through insurance even that can be handled through her existing insurance provider's Explanation of Benefits process.

Anonymous said...

She must have Goofmart confused w/ the chain on the corner of Happy & Healthy? They always advertise during open enrollment that they could do that very thing! Second, if she came in after December 7th (I might be off by a few days) isn't it too late for 2017?

Anonymous said...

It's not too late if this happened before 12/7, OR if she is in her initial enrollment period (due to turning 65 or qualifying based on disability or ESRD status) or otherwise qualifies for a Special Enrollment Period. General Med D enrollment is limited to 10/15-10/7 to be effective the following 1/1, but a ton of them happen year-round for a variety of reasons.

Anonymous said...

or she will