Dan S Oeu

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Aetna Medicare - Declined coverage of a previouly covered medication

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Having a similar type issue. What I discovered is they change the tier as they call it of a medication so that the amount the co-pay is higher than the retail price.

When the co-pay is higher than the retail the pharmacy then charges you retail instead because it is less. But the Silver Scripts plan still gets their insurance premium every month. Quite a Scam like appearance of the tier program of pricing scam..... Example a medication my wife was taking last year cost $30 on the plan until December when she was in the area they call a donut hole (?) then it was $6 for the same 30 days.

Switched to 90 days in December and it was $52 doing the math that is less per month than before. Today when to pick up the refill and was told the insurance had declined the medication and it was $61? Called Silver Scripts and was told the med was now tier 3 and the deductible was $105, but since the retail price was less than the deductible I would need to pay the Retail price. I ask what good the insurance was and was told well that's not the case for all meds.

I ask why would you put a medication in a tier where the deductible was close to double the retail price if it was not to have any pay out of insurance and she had no answer.

This took over a hour on the phone and two different people who contradicted themselves every other sentence. Makes you wonder how many seniors are now unable to afford medication because of this practice of over level tiering of the meds .

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Preferred solution: Fix the problem of placing medications into tiers that are so high the deductible is purposely higher than the retail cost of the drug!

User's recommendation: Investigate a Medicare D supplier before you sign up!

3 comments
Guest

You seem angry that the retail price is less that the copay. Is that the only med your wife is on?

Even if it is, there is no guarantee of not needing the insurance in the future. Also, you can just cancel the insurance if it bothers you.

Dan S Oeu
reply icon Replying to comment of Guest-2005912

True problem is the dishonest practice of setting the copay higher than retail price and obviously you have never tried to change a Medicare policy not during open enrollment periods.

Guest
reply icon Replying to comment of Dan S Oeu

Is that the only medicine your wife is on?

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