Tom Schrette and Alan Cash

Tom Schrette and Alan Cash

J.L. Sousa

Dear Tom and Alan:

I’m old enough to be on a Medicare Part D prescription drug plan and have been for a few years.

I really haven’t paid much attention to it because medicine has never been part of my daily routine.

I just paid almost twenty bucks for a little box of Allegra (for allergies).

How come this drug plan I’ve been paying into for years doesn’t have any benefit when I finally need it? Should I be looking for a new plan?


Tom: Let’s go backward on your questions.

First, you can definitely shop for a new drug plan when the Annual Enrollment Period (AEP) comes around again from Oct. 15 to Dec. 7.

This is the time of year when agents have to re-certify in order to sell the various drug plans offered by different companies so we can get the details on the 2017 plans.

So, when Oct. 15 rolls around, you can look into many different prescription drug offerings. However, none of them would pay for your Allegra.

Al: There are many categories of drugs that are specifically excluded from Medicare Part D plans.

On the list I got from Blue Shield, the very first one reads, “Non-prescription drugs (or over-the-counter drugs).”

Tom: To answer your other question, the benefit of your drug plan is that prescription drugs are covered and, if you didn’t have a plan in place, you could be subject to penalties added on to the cost of any plan you enrolled in on a later date.

Al: I was on a roll here.

Some of the other drugs specifically excluded from a Part D plan are those: used to treat anorexia, weight loss or weight gain; used to promote fertility; used for cosmetic purposes or to promote hair growth; used for the relief of cough and colds.

Tom: If you’re like many healthy people who only take vitamins … those aren’t covered either. You probably already know that Viagra is not covered.

Neither is Cialis, Levitra or Caverject (never heard of that one). A drug you buy outside of the U.S. is not going to be covered. That pretty much shoots down the Canadian pharmacies you hear about.

Al: In the case of our reader who pretty much doesn’t use the drug plan he has, we usually lean toward the least expensive plans.

Since you can change from plan to plan every single year it doesn’t make much financial sense to pay for a costly plan.

Tom: For those who do have some expensive medications prescribed for them, we typically compare the formularies of different companies.

One, to make sure the medication is on the list, and, two, to see how it’s covered compared to other companies’ formularies. Formularies change every year as do the rates for enrollees.

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