Seniors, Can We Talk?

Caroline Beauchamp is a local insurance agent for M & P Insurance & Investment Services. She offers personalized life and health insurance solutions and is known for her widelypublished informational column, ‘Caroline, Can We Talk?’.

Paul, a friend’s husband, called last week very unhappy – in fact angry. He recently was prescribed Eliquis. When he went to pick up his prescription, he was in shock when he was told the price, even with his Medicare Prescription card. (If you’re taking Eliquis or know someone who is, you know it is expensive.)

Paul said he wanted to change prescription plans – now! When I told him that, unfortunately, he could not change plans now. He can change plans during the Annual Election Period starting October 15 through December 15 and his new plan wouldn’t be effective until January 1.

This was not what he wanted to hear.

Let’s talk about some options Paul has today.

He can contact his Medicare prescription plan and ask for an

“exception”. He has the right to request coverage of a drug that is not on his plan’s formulary list or request coverage of a drug on his plan’s formulary list at a lower cost/lower tier.

If Paul’s doctor thinks Eliquis is the best drug for him and the drug is not on his plans’ formulary, either Paul and/or his doctor can apply for a “formulary exception”. How? Paul and his doctor complete a coverage determination form and send in his prescription plan.

Hopefully an exception would be granted. If an exception is not granted, he may appeal the determination.

I asked Paul what pharmacy he uses. He uses a standard pharmacy. Since he uses a standard pharmacy, he could change to a preferred pharmacy where he would have a lower copay. Since he has a longtime relationship with his current pharmacist, he didn’t want to make a change.

Paul could also keep his current pharmacy for all other prescriptions and just go to a preferred pharmacy to get his Eliquis. (He does not have to use the same pharmacy for all prescriptions.)

He could ask his pharmacist if there are any coupons to help with/ reduce the cost of Eliquis. He could also ask his pharmacist if there are any discount cards that could help with/ reduce the cost.

Paul can go back to the source –his doctor. He can ask his doctor if there are any lower cost drugs that will do the same thing Eliquis does. To make this easier, Paul can take his formulary directory with him. This is the list of drugs that his plan covers. The directory shows the “tier” a drug is on and any “management tools” that are required (quantity limits, prior authorization, or step therapy).

This is what Ruth and I talked about at lunch. Ruth had a similar situation a few years ago. After she spent a little time, asked questions, and reviewed her options she was able to get her prescription filled at a much lower cost than she originally was told.

If you’re having an issue with any of your prescriptions, consider these options I shared with Paul.

Got a question or concern? Call 501-868-6650 and say “Caroline, can we talk?” N