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Tom Schrette and Alan Cash

Tom Schrette and Alan Cash

J.L. Sousa

Dear Tom and Alan:

My doctor prescribed a medicine called Dutasteride (honest, that’s what it’s called).

I’m shopping to find a company that offers a drug plan that would cover this without costing an arm and a leg.

When I try looking it up online, it keeps saying “not found.”

What am I doing wrong?

Undermedicated

Tom: OK, since we’re in the Annual Enrollment Period (AEP) we can help you with your digging.

We had the same result as you did looking on the websites for AARP, Humana, Silver Script, Anthem Blue Cross and Blue Shield.

First of all, Dutasteride does exist, but it’s the generic form of Avodart. Sooo…once we put in Avodart into each of the drug search boxes on the different websites, up popped Dutasteride.

Now each company divides the categories of drugs into tiers. Tier 1 and 2 are usually generic (costs less), tier 3 and 4 are brand name (you know), finally, tier 5 is often injectables that are most expensive.

Al: The one that jumped out at me was the AARP drug plan.

Dutasteride is simply not covered. No tier, no nothing…you just pay $165 per prescription. All the others were either tier 3 or 4.

Since you now know the retail price, $165, the rate you’re currently paying, $41, sounds pretty good.

Next, because it’s very common, I looked up Flomax.

The AARP website says it’s not covered, so an individual would have to pay retail, or $238.67 per 30-day prescription.

At the same time, the generic for Flomax, Tamsulosin, is a tier 2 priced at $13.73 per 30-day prescription.

Tom: Be aware that with all drug companies, there is an appeals process if your doctor prescribes a medication for you where you get nailed with a very high price.

You may be able to get an exception if other substitutes or generics don’t work.

It is also the case that the formularies for the different companies change from year to year.

The medication you’re receiving this year at a certain price may not even be covered next year.

Al: That is very true and got me thinking about the recent EpiPen scandal.

According to The New York Times, the Mylan Company bought EpiPen in 2007.

In 2009, the price of a two-pen set was $103.50; in 2013 the price rose to $264.50; in May of 2016 there was a huge jump to $608.61.

For patients prone to strong and/or dangerous allergic reactions, many doctors recommend carrying the two-pen set.

For people over 65 and on a Medicare Part D drug plan, the AARP drug search indicates that the EpiPen is tier 3 and only costs $38 per month for those on their MedicareRx Preferred Plan. In the coverage gap (doughnut hole) the price jumps to $244.76.

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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