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September 30th, 2014

Shop early: the right prescription for selecting a Medicare drug plan

The most important shopping seniors may do this season is for a Medicare prescription drug plan. Therefore, it’s one holiday shopping item that shouldn’t wait until the last minute.

New research from Express Scripts shows 84 percent of seniors (based on an analysis of Express Scripts Medicare (TM) 2011 PDP enrollment data) wait until the last minute to select a Medicare Part D plan, and half of all seniors will attempt to enroll specifically on Medicare Monday – the Monday following Thanksgiving, the busiest enrollment day of the year. In addition, many seniors are not aware that the Centers for Medicare and Medicaid Services (CMS) changed the enrollment deadline in 2011 to Dec. 7, thus trimming the enrollment period by three weeks.

“As a result of down-to-the-wire decision making, seniors risk overpaying because they do not have the time to shop, compare and ensure the plan they choose covers all of their pharmacy needs,” says Paul Reyes, host of the Ask the Pharmacist radio series and pharmacist for Express Scripts. “Choosing the wrong plan could end up costing hundreds of dollars or more because you’re locked in until next year’s enrollment period.”

It’s important to start the process early so you have plenty of time to thoroughly compare plans and avoid long wait times and enrollment frustration. Reyes has the following tips to help you make the right Part D choice:

Look beyond the sticker price: While lower premiums are helpful if you do not currently take many medications, when you do need more medications, the costs of the medications can really add up. You should evaluate any out-of-pocket costs you’ll be responsible for based on the medications you take regularly, and make sure these medications are included on the plan’s list of covered medications. 

Star search: Beneficiaries should consider a plan’s CMS star rating – an objective comparison of important plan attributes and performance, such as patient safety and support. The CMS star ratings range from one to five, with four and five representing above-average plan performance.

Mind the coverage gap: The coverage gap, also known as the “donut hole,” begins when your total drug costs (the amount that both you and your plan pay) reach $ 2,970. Once you reach the coverage gap, you are responsible for paying the full cost of your medications until you hit a total of $ 4,750. Look for a plan that will alert you when you’re getting close to the gap and will help you stretch your Medicare dollars to delay or avoid it. If you use a lot of medications or have reached the gap in previous years, consider a plan that offers coverage in the gap.

Is there a generic for that?: Generic medications can help lower your monthly drug costs, thus delaying or even preventing you from reaching the gap. Many plans offer incentives for generics – for example, the Express Scripts Medicare Choice Plan offers a $ 0 copay on generics ordered through home delivery. The great news for Medicare consumers is that many popular brand name medications, such as Lipitor, are now available in generic form.

Care and convenience: A plan that offers round-the-clock pharmacist support can help you get the support you need from your plan – even if it’s the middle of the night, plus may offer you ways to help you stick to your treatment regimen and avoid potentially harmful drug interactions and side effects. Plans that have a national pharmacy network can make a lot of sense if you travel or spend time away seasonally – plus look for other ways to save – such as through home delivery for chronic medications. These savings can really add up.

Play it safe: If you’re shopping for a Part D plan online, be sure to start with www.Medicare.gov, the official U.S. Government website for Medicare, to ensure you are signing up with a CMS-approved Medicare Plan. Also, if you order medications online, look for the site’s VIPPS certification to ensure you are buying medications from an online pharmacy licensed by the National Association of Boards of Pharmacy.

So when enrollment begins on Oct. 15, start comparison shopping for a plan early  on and review the above information to help find the plan that’s right for you. For more information regarding how to choose your plan, or to sign up for free reminders to ensure you don’t miss the enrollment period, visit www.Express-ScriptsMedicare.com.

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