When viewing the Plan Results for prescription drug plans on the Medicare.gov plan finder tool, a list of plans is displayed. When a plan is selected, and the "Drug Costs & Coverage" tab is selected, there is a section titled "What you Pay." This section includes the selected drugs, the "Full Cost of Drug", Refill Frequency, Initial Coverage Level, Coverage Gap, and Catastrophic coverage amounts for the selected plan. If I then choose a different plan with the same pharmacy and view the "What You Pay" section, the Full Cost of Drug amounts are different. How does Medicare determine the "Full Cost of Drug"? Where do these numbers come from?
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Where do the Full Cost of Drug prices comes from?
- Thread starter rmartin68
- Start date
Mack said:
I have reviewed formularies for every plan in Texas. Not one of them has drug pricing. They have different tiers for each drug in the plan, but no pricing.
And just to clarify, the prices are different for each *pharmacy* and each *plan*. I can't imagine a formulary having pricing for every possible different pharmacy.
If you're looking for pricing, my site has the tiers and drug copays listed which may help you find the right Medicare Part D drug plan. I'm not sure where they're pulling the full cost info from?
thanks,
Matt
thanks,
Matt
rmartin68 said:
I paid CMS $250 for the public use file that contains all the tiers and copays and deductibles and premiums for every PDP and MA-PD plan. This file is available monthly.
There is another CMS file for $750 that includes the pricing, but this file is only quarterly.
On top of that, it does not provide pricing per pharmacy, just an average price for all the pharmacies in the region which the plan serves.
So, in other words, the Public Use File is averaging the pricing for every pharmacy in a state that a Medicare Part-D plan serves. Gee, that helps.
How can anybody possibly match Medicare.gov values?
I will tell you. They can't.
I entered the identical drug list, pharmacy, and zip code into the company sites for various plans (AARP, Blue Cross, Aetna, Wellcare, Cigna, etc) and the companies themselves aren't matching Medicare.gov.
There is another CMS file for $750 that includes the pricing, but this file is only quarterly.
On top of that, it does not provide pricing per pharmacy, just an average price for all the pharmacies in the region which the plan serves.
So, in other words, the Public Use File is averaging the pricing for every pharmacy in a state that a Medicare Part-D plan serves. Gee, that helps.
How can anybody possibly match Medicare.gov values?
I will tell you. They can't.
I entered the identical drug list, pharmacy, and zip code into the company sites for various plans (AARP, Blue Cross, Aetna, Wellcare, Cigna, etc) and the companies themselves aren't matching Medicare.gov.