Good point. I wonder if the pharmacies will give us that information . . . ?

I'm not sure, but I'll start calling around.

But something I find interesting is that Medicare has set price caps for Doctors' services. They only allow a set amount and any amount charged over this fee is not billable to the patient and is "written off" by the doctor.

Yet, the pharmacies are allowed to independently set charges for Medicare prescriptions without any allowable charge limits.

I called Medicare and asked to speak with someone who could give me the information about Pharmacy charges and it seems there is no one with that information. They just have never bothered to keep records of this nature and they don't plan on doing so in the future.

Just go to the pharmacy and ask.
I did this a couple of weeks ago...took some scripts and asked what their charges would be if i got them filled there.

Seems it is a very normal thing to do...shop around for the best price.

Forgot something....I'm not on Medicare, but I do have a prescription drug plan with my health insurance. Shouldn't work any differently with Medicare's drug plan.

I believe Congress voted against letting Medicare bargain for set prescription drug prices....ask your congressman how he/she voted.

Seems the drug companies have a stronger lobby than the doctors.

well I am hoping I can help once again. I am a Medicare insurance specialist. I will tell you that no matter what Medicare RX plan you have, a GOOD pharmacy will give you the lowest rate they can, regardless of what your co pay is. You may have a Humanna RX with $4.00 co pay or a BCBS co pay of $5.00 or Priority with a $10.00. I have found Walmart will always give you their cost price no matter what insurance you have. BUT YOU HAVE TO ASK! Ask YOUR Pharmacy if they do the same. Please understand that Medicare reps (I used to be one) do not have information on what insurance companies pay for RX. Trying to save you a long hold time on the phone for no info! I have also found that the Mom and Pop drugstores that are near retirement homes or subsidized rent complexes have the best prices and compete with Walmart. You need to look at the plans formularies to see if you have tier 1, 2 or 3 drugs. One plan may have a drug you use as a tier 1 (cheapest)and another may list it as a tier 2 (more expensive) this is why you need a good agent to check this for you. There are very few plans that will help you though "the GAP" or "doughnut hole" as it is called (other than generic drugs) so don't pay extra in an insurance plan for "gap " coverage (trust me), however many Pharmaceutical Manufacturers offer low to no cost drugs through this "gap". Most people never get to "the gap" and those that do usually are there with only one or two months of full paid RX. It is important to apply to these programs early as it takes up to 2 months to get assistance. If you know you are going to hit the "gap" in a certain month apply 2 months before. Things like Advair Discus etc. can be delivered to your door FREE if you know where to look. Again I will tell you to contact your nearest Area on Aging for more information on all these tips. Do not take offence in the name...you are young but you deserve the assistance they can offer for all sorts of things. To find your nearest office call Elder Care Locator @1800-677-1116.
Hope this helps!

I don't know how this works but after DH was dismissed from hospital he was given a prescription to be filled. Took it to Walmart they told us $90 because insurance wouldn't pay for it. DH said, he didn't want it. Came home and called insurance and they said, they didn't pay for it cause you can buy it over the counter. Walmart didn't tell us that. Went to cvs couldn't find the item so asked the pharmacy and they had it there but it was only $32 for the very same item. I called doc office to ask why they wrote a prescription for it if i can get it over the counter. They told us they just wrote it on a script pad so we'd be sure and get it. Big difference in price what's with this.
If DH hadn't been stubborn we'd paid that $90 price and it needs to be taken six months.

Lisa, thank you for the info. I'm raising this question because I always thought in terms of co-pays as a cost cutting measure. I never thought about the hidden costs cutting into my Rx coverage.

I'm not talking about a co-pay charge; I'm asking about the charge the pharmacy passes on to Medicare. The greater the charge, the sooner the $$ are used up before we reach the "Gap". Medicare says it keeps no records of drug costs as supplied by dispensing pharmacies.
I think it is in our best interest to know what these charges are and it seems there isn't any easy or quick way to find out.

The way it stands now, it means that 2 different patients with the same Rx could reach the "Gap" at different times with the difference being several months of refills either covered by Medicare or being paid for out of pocket.

I'm wondering if the low co-pays are being supplemented by greater reimbursements from Medicare and thus ultimately costing us more in out of pocket expenses.

Re: the medicare prescription question

Is our state unique? In our state, if you're on the medicare and our state senior drug plan, the patient pays only $5 for a 3 month supply of any med they're on. The state pays the premium for the medicare plan AND any excess over $5 after medicare has paid their portion.

Perhaps, if medications are still costing too much, it would be worth having your AARP local groups band together to cencourage your states to institute a similar plan? I know my mom and aunt have saved thousands of $$$$ because our state has put a high priority on taking care of the health of our senior citizens.

azzalea, that's not what I'm talking about.

I'm talking about the fact that the Rx plans will cover your meds, with you paying a co-pay, up to a certain $$ amount. Then you enter the "Gap" where you pay for all your meds out of pocket for a certain amount of $$ and then you re-enter the system where you pay your co-pay and the drug plan covers the meds again.

The basic amount spent from your "account" is tallied by how much your Rx meds cost the Medicare system. If one pharmacy bills Medicare $15.00 for a Rx drug and another pharmacy bills Medicare $25.00 for the same Rx drug, then one patient is going to reach his max sooner than the other will.

If this happens with multiple prescriptions it could make a difference of several months of refills being paid for by the drug plan or the patient.

If doctors' fees are the same across the board for every medicare participating doctor, then why aren't dispensing pharmacies held to the same billing requirements?

And why doesn't Medicare have an available list of medicine costs as charged by pharmacies that we can access to determine where we can compare prices? We can do that with the drug plans, but we can't do it with the products they will supply us.

Medicare is a really odd bird. Monablair mentioned that they cap what a doctor can charge a Medicare patient and the patient doesn't have to pay anything over the cap.

Well I just wish they'd look more closely into that cap on what a doctor can charge and make it more realistic. Many doctors won't take new Medicare patients because of the low reimbursements. My Dad needs an injection of Aranesp every 6 to 8 weeks to treat his anemia due to chronic renal failure. My Dad's physician and many others no longer give the shot because Medicare reimburses less than the medicine actually costs. And that doesn't include any of the costs that are associated with the injection - the support staff, the doctor's time, the syringe etc. I now have to take him to a specialist for the injection - and he also loses money on the shot too - but he has treated my Dad for years and will continue as long as necessary. It just doesn't make sense.

I found out the hard way that Medicare won't pay for anything you can buy over the counter, such as Zyrtec (for allergies) and vitamins. . I need to take a potent form of vitamin D for my kidney failure.

it's guaranteed that reimbursements will be going down and more and more dr's will be getting out. can you blame them? it not at all profitable to see medicare/medicaid patients and most of the time costs more so why drive your business into the ground to serve a segment of the population? what other industry or business follows this model.... ~ liz

little talked about future changes coming soon...
http://www.treas.gov/press/releases/hp886.htm

Here is a link that might be useful: social security & medicare problems

I'm about to enter into the Medicare twilight zone. I've been inundated with plans from every company that serves Florida, I think. All it does is confuse me even more.

I know I need to take Part D (prescriptions) even though I'm not on any. That's because for every year you don't sign up you pay more. (Or at least that's what I think I'm reading.)

So, does anyone have any idea the best way for me to go on this? I'm really frustrated!! Why the heck do they have to make it so complicated? Lord knows, I only have a half a brain left as it is!

A little off the subject, but when I go to the doc I always ask if they have samples they will give me. I have some scripts I never have to have filled b/c they give me sacks full at the docs. Those pharmaceutical reps leave tons of those samples. My doc's nurse told me they have closets full of samples medications. I haven't paid for Evista or Actonel or Toprol,in years. Just ask! They're kinda glad to get rid of that stuff!

patti43, after much research we decided on UHC Plan J as our supplement plan and the AARP Rx plan also through UHC.

And you're right...if you don't sign up for a Rx plan now then if you sigh up later the premiums will be higher. At this point in time I'm not on any medications, but that will likely change in the future. So, caught between a rock and a hard spot, I signed up for a Rx plan.

mcmann, all insurance reimbursements to Doctors are based on the allowable amounts designated by Medicare. Other insurance companies only pay a % of what Medicare would pay and the balance is simply a non-collectible write-off.

This is a shame because the elderly segment of our population is left out in the cold trying to find doctors that will accept them as new patients because their doctor has stopped accepting Medicare or has retired. And I can't really blame them for not wanting to work long hours only to find that they've collected less than their expenses.

Monablair--that IS what I'm talking about. My state picks up EVERYTHING but $5 per prescription. There IS NO gap for medicare patients who qualify for the state prescription plan. Note we had a state prescription plan before the federal went into effect, so they just continued along the lines of the original state plan (and now the state is saving money, because the federal program is picking up part of the cost--they're just paying for what the state doesn't--minus the $5 per 90 supply co-pay).

The point I'm making is that perhaps you can get your state to offer coverage to pick up what you're paying out of pocket.

My aunt and mom saved thousands of $$$ a year, for many years with that plan, and no, there was never ever any out of pocket expenses--except the $5 copay. And the qualifications were pretty liberal. Mom had close to $200,000 in investments, plus other assets and she qualified.

azzalea, what state do you live in?

NJ--who had perscription help for seniors long before the feds even considered one. The feds originally looked at our plan, to model the fed after it, but it falls far, far short of what NJ offers their respected senior citizens. (there never was any kind of 'premium' to get the coverage).

My in-laws live in NJ and when we went up to visit last time we had this same discussion. They fall into the crack of having too much income and are NOT eligible for the program you are talking about. They have to choose a plan and must pay co-pays out of pocket of, say $40.00 for a 90 day supply of ambien. They get most of their scripts thru Medco at those types of co-pay and hardly any of the meds that they take are available at the Wal-mart, K-mart or other $4.00 type plan. So much of their $ is spent on medicine . It is sad.

My mother lived in NJ, and also was not eligible - not because of income, but because of total assets (including value of her home)...and she was not wealthy.
She had to pay for her own drug plan.

Yes, that is what I mean, my in-laws are not wealthy either. Years ago when they planned for retirement, they couldn't forsee how much things would cost. No-one could have.. They are eligble for the Homestead Rebate program and got the stimulus check this year, and all of it goes to pay taxes. sad.