Recently as a result changes caused by Obamacare my former employer moved retirees into an Employer Group Waiver Plan (essentially an employer sponsored Medicare Part D plan). Many other employers did the same thing because Obamacare would cost them money if they did not take such action.
Such a conversion from an employer designed and operated plan to one governed by Medicare rules can be confusing. I just received my information package about the change effective January 1st. I’m not the typical retiree having spent nearly fifty years designing and managing employee benefits.
The information package included a new list of formulary drugs, drugs that receive a rebate from the manufacturer. If you receive a prescription for a non formulary drug, you pay more so it’s in the patients best interest to use the formulary. That means you may receive drug A over drug B when both drugs treat high cholesterol as an example, drug A being less expensive. Such choice boils down to money when both drugs are judged to be clinically as effective.
The list of formulary drugs is forty-five pages long in an 8-1/1 by 11″ booklet. I am wondering if I am to memorize the formulary drugs or to take the booklet with me to each doctor visit in the event I am prescribed a drug so that the doctor may peruse the 45 pages before writing the script.
The information I received also says my doctor is required to get prior authorization for “certain” drugs and that “in some cases, you are required to first try certain drugs to treat your medical condition before we will cover another drug for that condition.”
There is that certain drug again.
While all this is aimed at managing costs, how in the heck is the average person supposed to comply before getting caught in the middle or hit with extra costs?
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- Q1Medicare.com Drug Search Tools Now Updated with 2013 Medicare Part D Prescription Drug Data (prweb.com)
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