SOME of the links may give you an alert. My security settings are EXTREMELY sensitive and sometimes I get a warning (in Chrome) that I ignore and go on. I have used every one of the sites and all of them are SECURE. Tablets are especially sensitive to links that take you to another country.

If you don’t read any other newsletter this year, read this one! Keep it and read it again. Forward to your friends. Just read it.

Good news for those with REALLY expensive medications . . .

Starting January 1, 2024, once your out-of-pocket spending reaches $8,000 (including certain payments made by other people or entities, including Medicare’s Extra Help program, on your behalf), you’ll automatically get “catastrophic coverage.” This means you won’t have to pay a copayment or coinsurance for covered Part D drugs for the rest of the calendar year.

https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/catastrophic-coverage

IMPORTANT NOTE: Your PDP is complicated and often convoluted. The $8,000 figure noted above does not mean YOU have to pay that amount yourself. Often a LARGE portion is paid by your drug plan.

I have a client who is currently taking a VERY expensive drug . . . the RETAIL (full price) cost is $6,000 per month. Her projected cost for 2024 is $3300 FOR THE YEAR! Her $0.50 monthly premium PDP covers the difference in $3300 and over $70,000 retail cost.

And for the rest of us . . .

Generic drugs are the way most of us can keep more dollars in our bank account . . . but only your doctor agrees that generic drugs will work for you, and if you are willing to put forth a little effort to find the savings.

MAIL ORDER 

https://www.costplusdrugs.com/

Discount Cards

https://www.goodrx.com/

https://www.singlecare.com/

Inhalers seem to be more expensive than others this year. Also, sometimes BRAND names are on the drug formulary but generic is not. If you are using generic forms now, compare the pharmacy price with the mail order and discount cards shown above.

Also . . .

Consider comparing brand and generic pricing from Canada. 

Maple Leaf has been consistently competitive for the meds I have checked.

https://www.mapleleafmeds.com/drug/flovent-hfa/

Expensive brand names and generics from Canada

I have recommended ordering from Canada for over 20 years and never had a single complaint. Rachel and I have also personally ordered from Canadian pharmacies from time to time.

HOWEVER, sometimes the lowest price is not your best choice. If you look for pharmacies with the CIPA label your selection may be more desirable.

Canada Options (CIPA members) - Generic or Brand

https://www.mapleleafmeds.com/

https://www.canadapharmacydelivery.com/

https://www.canadapharmacy.com/

https://www.northwestpharmacy.com/

https://www.blueskydrugs.com/

Link to CIPA member pharmacies

https://www.cipa.com/cipa-safe-pharmacies

GREAT DEALS ON BRAND NAME MEDICATION 

Deals Direct from the Manufacturer

https://www.eaglepharmacy.com/

WALGREENS ONLINE SPECIALTY PHARMACY

Managing your complex, chronic or rare conditions, such as cancer, Crohn’s, UC, CF, Hep C, HIV, MS, RA

Consultations with specially-trained pharmacists, face-to-face or by phone

Specialty medications

Used to treat chronic, rare or complex conditions, these medications may:

Be given by infusion (intravenously), injection or taken orally

Cost more than traditional medications

https://www.walgreens.com/topic/pharmacy/specialty-pharmacy.jsp#medications

A word about Part B Covered Drugs . . .

Drugs used with an item of durable medical equipment (DME): Medicare covers drugs infused through DME, like an infusion pump or drugs given by a nebulizer, if the drug used with the pump is reasonable and necessary.

Injectable osteoporosis drugs: Medicare covers injectable osteoporosis drugs if you meet all of these conditions:

You're a woman with osteoporosis who meets the criteria for the Medicare home health benefit.

You have a bone fracture that a doctor certifies was related to postmenopausal osteoporosis.

Your doctor certifies that you can’t give yourself the injection or learn how to give yourself the drug by injection.

Find infusion center for Prolia

https://www.proliafinder.com/

Injectable and infused drugs: Medicare covers most injectable and infused drugs when a licensed medical provider gives them, because these types of drugs aren't usually self-administered.

More . . . https://www.medicare.gov/coverage/prescription-drugs-outpatient

NOTE - If the drugs are supplied by your doctor, or an INFUSION center, the cost of the drugs is covered by Part B and your Medigap plan.

But if you are given a PRESCRIPTION, and told to fill the drug at your pharmacy, the drug will be submitted to your Part D plan  . . . and will cost you a LOT MORE out of pocket.

If your doc refuses to supply the drug, tell then you want to have it administered at an INFUSION center.

Search for “local infusion centers” if your medication qualifies for Part B coverage.

MEDICARE ADVANTAGE(PPO) PLANS 2024

Many people who become severely ill or injured regret choosing Medicare Advantage. But extra perks — such as $0 premiums, vision and dental coverage, and now newer additions like grocery stipends — have proven to be too enticing, especially for people who don’t have a lot of money.

Medicare Advantage enrollees who are healthy have benefited from those kinds of plan features, but interviews with sick and injured enrollees, family members, and brokers have painted a picture of buyer’s remorse. People in a Medicare Advantage plan who need intensive care — like rehab in a nursing home — often are appalled when they are told their insurer denied payment for their care.

https://www.statnews.com/2023/10/15/medicare-open-enrollment-period

That’s all for now. Lots of helpful information here. Probably one more newsletter for the year . . . early December.

Feel free to share this newsletter with your friends.

Hope you have a WONDERFUL Thanksgiving.

bob