Dear Tom and Alan:

I’ve been debating with myself about changing my prescription drug plan because it seems at least one of my medications has gone up in price over a very short time.

It’s hard because everything is set up with my local pharmacy and how would I know if what I change to is even worse?

Also, the cost of my plan goes up every year. Can companies just change the price of a drug whenever they want? How about all the junk mail I get from different plans for at least the past month?

What do you recommend?

No Dope

Tom: All good questions. We can’t really recommend any specific plan without knowing the details of your individual Medicare Part D plan.

Your junk mail corresponds to the Annual Open Enrollment Period (AEP) from Oct. 15 to Dec. 7. Companies can change the price of a drug after giving 60 days notice to their members.

Companies can also change their complete formulary beginning Jan. 1. Those with more than one plan usually have a different formulary for each one they offer.

Al: The federal Medicare Part D plan is kind of an odd duck.

Since its inception in 2006, the Center for Medicare and Medicaid Services (CMS) each year sends out a detailed description of the “Standard Part D Plan Benefits” for the following year.

The government turns the whole thing over to the individual insurance companies to carry out the program. Most companies offer the “Standard” plan along with one or two others that exceed the minimum.

For example, Anthem Blue Cross has three different prescription drug plans for 2016: the Standard plan is $45.20 per month; the Plus plan is $81.70; and the Gold plan is all the way up to $132 per month.

Humana also has three prescription drug plans for 2016: the Walmart Rx plan for $18.40 per month; the Preferred for $27.30; and the Enhanced for $73.20 per month.

Tom: When we meet with people shopping for a drug plan, we usually run a quote from different companies to see how an individual medication would be covered under a specific plan.

Once we know the name of the drug, the dosage and the frequency, we can generate a statement showing how much the person could expect to pay.

Along with the differing formularies, most companies have at least five tiers to indicate how a drug is covered. Tier one is very common generics (least expensive); tier two is generics that aren’t so common; tier three is brand name drugs; tier four is usually brand names that are less common (and more expensive); tier five is injectables and specialty drugs.

Al: For those of our readers having difficulty sleeping, I have a copy of the Standard Part D Benefits for 2016…including the doughnut hole!

Submit questions or reach the Health Insurance Guys at Schrette Insurance, 1556 First St., Suite 105, Napa, 94559; 255-9511; schrette@gmail.com; or alancash@gmail.com

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