Choosing a Drug Plan
Dr. Bruno’s Original Post: For those in the US, it's time to start thinking about health insurance for next year. I want to warn you about changes in your drug plan that you may not be aware of (I realize they may not make sense).
All medications in Medicare part D drug plans are assigned a “Tier.”
· Tier 1 is the least expensive, often older generic drugs,
· Tier 2 is for generic drugs
· Tier 3 is for brand-name drugs while
· Tier 4 is for “non-preferred” drugs
· Tier 5 is expensive specialty drugs.
What the insurance companies don't tell you that they can change a drug’s Tier every year.
For example, one drug plan has listed generic diazepam (brand name Valium, which has been around since 1963) as a Tier 1 drug. But, in 2017, the same generic diazepam will be listed by the drug plan as a Tier 4 drug, a "non–preferred drug.” The price for Tier 1 generic diazepam had been $15 for 3 months. Come 2017, the price for Tier 4 generic diazepam will be $343 for 3 months!
Why, you ask, would a generic drug that's been around for 53 years be switched from Tier 1 to Tier 4? For that question I have no answer. But imagine how you would feel if you didn't check the Tiers and prices for 2017 and bought generic diazepam through your drug plan. You would go from paying $60 a year to $1,372!
So I highly recommend that you call your prescription drug plan and find out the Tiers and costs for all of your medications. But remember that you don't have to buy all of your medications through your drug plan. You can go to http://www.goodrx.com/ and find the prices you would pay for your medications at local pharmacies, pharmacies inside big–box stores (Target, Walmart, Stop & Shop) and by mail. Using diazepam as an example, a three-month supply bought through one supermarket’s drugstore would be $19 for 3 months. What's more, some of the big-box stores and pharmacies also have discount cards that can reduce the price even further.
If you find that your drug plan charges more for some medications than does a local pharmacy, you can ask your doctor to send prescriptions for reasonably priced medications to your drug plan while you take a handwritten prescription to your local Walmart and pay cash.
Note: This article was written in October, 2016 so some of these examples may (or may not) have changed. Either way, it’s a good guide to start your research.