The annual Medicare Part D open enrollment period can be a stressful time for seniors and caregivers trying to pick the best prescription drug plan available. Sona Pharmacy has invested in technology and special training for our pharmacists to guide you through this process. It is important to remember that every eligible Medicare member has unique needs and there is not a “one size fits all” best plan. Many variables factor into the “best plan” equation for each member. Members’ needs and plan options change every year, making it crucial to re-assess your situation annually. We have found that many members are leaving money (sometimes thousands of dollars) on the table each year by not picking the best plan.
There are many things to consider when picking out the right plan for your needs. All companies that offer Part D plans have something called a formulary, which varies by plan. The formulary establishes what medications are covered, what medications are excluded, and what medications require a prior authorization. These medications are typically broken down into tiers, which determine how much your copay will be for each drug. Part D plans have different premiums which you pay each month to the plan in return for drug coverage. Also, depending on the plan you choose, you may have to pay a deductible (capped at $400 in 2017) before your coverage begins.
Some companies that administer these plans also have preferred networks and different contracts with different pharmacies within those networks. Some plans even have preferred networks that force members into getting mail order prescriptions to get lower copays. This means, depending on the plan you choose, you may pay different copays at different pharmacies. If pharmacy choice is a driving factor in your decision making, your best bet is to first establish the pharmacy you want to use. Then, ask your pharmacist at your pharmacy of choice what the best plan will be for you at their location.
Sona Pharmacy offers a free plan comparison tool to help patients navigate the Part D open enrollment process. Our pharmacists will take your medication list and compare the available Part D plans to show you your best options. Our comparison tool will break down plans by total out-of-pocket cost on an annual basis and deductible amounts, premium amounts, and copay and coinsurance amounts on a monthly basis. We can even help you identify when you will go into the part D coverage gap (i.e. “donut hole”) and if a plan doesn’t cover one of the medications you are currently on. While we cannot endorse specific plans or guide you to any particular plan, we can help by giving you all the information at our disposal to help you make the most educated decision possible.
It is important to note that our plan comparison tool is specific to our pharmacy and will not necessarily give an accurate estimate of what an individual would pay at other pharmacies. If you are interested in receiving a free plan comparison for 2017, please call our pharmacy, stop by, or send us an email. We will need your demographic information, your medicare information (i.e. a copy of your “red, white and blue card”), and your complete medication list. A pharmacist will use this information to print off a comparison of different plans for you. We will then reach back out to you to schedule a time to review your plan comparison by phone or in person. Our comparison tool provides plan enrollment information and breaks the numbers down nicely to give you an idea of what you would pay monthly and annually.
If you are dual eligible (on Medicare and Medicaid), you may change Part D plans at any point during the year. If you have a standard Part D plan, open enrollment for 2017 runs October 15th to December 7th of 2016. Call or email today to ask for your free Medicare Part D plan review! You can reach Sona Pharmacy at (828) 298-3636 or [email protected].