Question; I was looking up my medications on www.medicare.gov for 2020, but I think something it wrong. It had one of my medications costing more than $60,000?? It is usually not more than $200 full cost? What is happening? Could this be correct?
Answer; Centers for Medicare & Medicaid Services (CMS) has just launched a new updated website for www.medicare.gov. This had led to a number of changes in how the website works. I recently wrote an article about it now requiring/requesting you set up a login to use the website to its fullest potential.
Your issue is another issue we have run into periodically since 2006. As the computer programmers update insurance information it sometimes miscalculates the data. We have seen this happen this year in sometimes an extreme version, (like yours). I bet you and I were looking up the same medication because this happened to me as well. I was working with a client and looking up the medication Flovent, which is a very common inhaler. It came up as covered by almost all the plans, but the total cost of the medication was over $65,000 per month. Now this medication is about $200 to $300 full price at most pharmacies, so I know that calculation is off. But because of the incorrect price, we had a very difficult time deciding on which plan to choose for 2020.
In a different appointment we looked up another medication, which was very inexpensive, under $50 full price usually, and it came up as costing over $2,000 per month. Now in the past we have had medications increase in cost, sometimes large increases, but both these situations are simply about bad data.
When I was first using a computer, I remember my teacher telling me, “Bad data in, bad data out!” I think that is what is happening.
As the programmers are creating the programs to take the insurance’s coverage rules (tiers & costs), the pharmacy coverage rules (standard or preferred) and how these two merge to create your pricing for your medications. Then taking all those different plans and all their different pricing scenarios and creating a list compiled in a variety of ways. Computers are great at doing that, as long as they are programmed correctly.
My first suggestion is; When using the website, you are often given the opportunity to complete a survey about your experience. This survey is a wonderful opportunity to inform them of the problems you came across as you used the website. Both of these instances, are good illustrations of what can go wrong in programming.
Another way to inform them of your problems today is to call 1-800-Medicare (1-800-633-4227). This will connect you with their customer service staff and you can report your problems today with the website.
In both the situations that happened to me, I had the opportunity to complete a survey and used that comment section of the survey to communicate my problems with the pricing of the medication.
The other step to this process is deciding which plan to use for your 2020 coverage. We are trying to use this data on the website to make that decision. When you get bad data, you can’t make your decision.
My second suggestion is look at the amount of medication you are getting. One of these was 180 Flovent Inhalers a month?!? When we corrected the amount of Flovent Inhalers to 1 per month, it corrected the $.
My third suggestion is for this researching step in the process, is to put your research on hold. Don’t give up, but wait a week or so. After you report your concerns, give them time to fix the problem. Since it is still early October, you have more than enough time to wait until the data is corrected. Once corrected data is available, you can make your informed decision on your coverage for 2020.
As we approach the October 15th launch to the Annual Open Enrollment Period, we are seeing daily changes to the data on the website. Sometimes this data is correcting earlier problems, sometimes it isn’t as successful in correcting the problem. Some of the corrections have created new problems.
Each year this has been a small problem, but this year with a whole new website launch, this issue has become more of a concern.
To contact Janell Sluga, GCMC with insurance questions or concerns, please call 716-720-9797 or e-mail at email@example.com.