Drug Not Covered...Try Using a Formulary Exception Request!

By Marc Manor

From time-to-time, I receive a call from a client who was prescribed a medicine that is not covered by their Medicare Prescription Drug Plan.  This can happen for any of a number of reasons but most of the time it is either because the drug is not on the plan's formulary; or it was not prescribed for use in a way that is approved by the Food and Drug Administration (FDA), or Medicare.  In most cases like this, you can request a "Formulary Exception Request".

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The Formulary Exception Request is usually a form that the prescription writer (doctor or other authorized professional) will fill out to request coverage on the drug that is prescribed.  In some cases there may be a generic or other brand name equivalent that can be prescribed; in this case, the insurance plan may have the doctor write the prescription for another covered drug, or request "step therapy" to transition the patient into the covered drug.  If there are no other alternatives, the insurance plan might make the "exception" and allow the drug to be covered.

Some drugs are very expensive and could be cost prohibitive without insurance coverage.  The Formulary Exception Request could be a real life saver in those situations.  If you find yourself in a situation where you do not have coverage, I recommend at least trying the Formulary Exception Request.  They are not guaranteed to be approved, but it could save hundreds or event thousands of dollars if they are.

So what if the Formulary Exception Request is not approved?  There are a number of reputable drug discount plans and other resources we can recommend to help ease some of the expense, including government programs.  Call us for a no-cost, no obligation consultation and we would be happy to work with you on a solution!

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.

Prescription Drug Readiness

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by Marc Manor

If you take prescription drugs, it would be wise to take inventory of your medicine cabinet and make sure you have adequate supplies to get you through the worst-case scenario. Most insurance plans offer mail-order options with online refill requests and some pharmacies are helping with delivery as well. A 90-day supply can be requested on some prescriptions. If you take meds that have quantity limits you can request your insurance plan and pharmacy to waive those requirements during the crisis.

Doing things like cutting pills and skipping days may be harmful to your health and should be avoided if at all possible. People taking drugs for diabetes are especially at risk.

If your prescriptions are expensive, call us at 904-222-0698 and we can help direct you to discount prescription drug or government programs that may be able to help.

Here is an article from "EverydayHealth.com" that has more helpful information:

https://www.everydayhealth.com/infectious-diseases/coronavirus-and-prescription-medications-should-you-stock-up/

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.

Medicare Prescription Drug Growing Pains 2020

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Have a new Prescription Drug Plan for 2020? If so you may be experiencing some "growing pains" associated with moving to a new plan. Plans sometimes have different formularies and there are other requirements such as pre-authorization (PA) and Quantity Limits (QL) that may be required that cause delays on processing your prescriptions. Be sure to put your first fill/refill in with a least 5 working days in advance of your need to allow these requirements to process. Call us at 904-222-0698 or email marc@marcmanor.com if you have questions!

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.

Happy Medicare Advantage New Year!

Happy New Year and Congratulations if you have a new Medicare Advantage Plan for 2020!  I am very excited for the new year and I resolve to make sure all my clients make the most out of your Medicare Advantage Plans this year and beyond!  Here are some tips to help you make the most out of your benefits:

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- Be sure to let your providers know if you have a new plan for 2020 so they can properly process your claims.

- Be sure to stay in network!  PPO plans offer out of network coverage; however you will pay more so when you make your appointment, you should double check.  Most providers will "take" a PPO plan so be sure to ask if they are "in network".  If you have an HMO you must stay in network.  Your provider should know when they refer you as long as they have your updated insurance information.  HMO plans do not normally have out-of-network benefits so being sure you are in network is more important for you.

Prescription Drug Prices Are Enough to Make You Sick!

by Marc Manor

There are many divisive social and political hot button issues but one I think most people would agree on is the issue of the high cost of prescription drugs in America.  I believe Medicare is a great system but it falls woefully short when it comes to prescription drug coverage for higher cost drugs.  Private insurance companies follow a model provided by Medicare but that is simply not enough.  Sometimes I talk to people who take two or three high tier drugs and I can’t help but to feel somewhat angry about what they are having to deal with to maintain good health.  

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I know I’m not the first person to bring this up, but I am piling on because I think that we all need to keep the pressure up on the government and the pharmaceutical companies to protest just how insane these costs really are.  To illustrate just how ridiculous the price of prescription drugs can be, I created an example we will call “Joe”:

Statements of Financial Responsibility

by Marc Manor

So, there you are at your pre-op appointment with your surgeon and you are asked to sign a “Statement of Financial Responsibility” or similar document.  This document is the “Cover Your Assets”/CYA insurance for the providers involved in the procedure.  Even the most minor surgeries can cost tens of thousands of dollars, so it is not surprising with the expense of healthcare these days, providers want some CYA.  I think they also do this to motivate patients to submit complete and current insurance information.  These acknowledgements are required by providers even if you have comprehensive healthcare coverage. Here are a few steps you can take to increase the chances your claims are properly processed.  

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Here are some things you can verify with your provider and insurance company to make sure you have the required coverage:

Tricare For Life and Medicare Advantage

By Marc Manor

Until very recently, I believed that retired military personnel using their Tricare For Life benefits would not have a need for Medicare Advantage plans; however, because of the numerous additional benefits available in many Medicare Advantage plans, I have come to realize that Medicare Advantage may bring additional value and healthcare options to my retired Veteran brothers and sisters when used in conjunction with Tricare For Life.

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First let’s talk about Tricare For Life.  Tricare For Life is a benefit earned by those career military personnel who are “retired” from the military.  It is considered “wrap-around” coverage for those retired military who have both Medicare Parts A and B.  While there is typically a monthly premium for Part B, there is no charge for the Tricare For Life wrap-around coverage for those who qualify.

While in many ways, Tricare For Life works similar to Medicare Supplement Plan F (the most comprehensive Medicare Supplement plans), yet it is different because one cannot use a Medicare Supplement plan in conjunction with Medicare Advantage (Medicare Part C).  Hence the term “wrap-around coverage”!  The reason this is so significant is because retired military members with Tricare For Life can use their benefit in conjunction with Medicare Advantage and therefore have three layers of Medicare insurance coverage!

Why have multiple layers of Medicare healthcare coverage you ask?