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Author Topic: Changes ahead for Medicare Pt. D drug program  (Read 5185 times)

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Offline Miss Philicia

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Changes ahead for Medicare Pt. D drug program
« on: November 03, 2007, 01:59:36 PM »
Thought I'd throw this up and perhaps others can share if they are having to make any changes.  This is just an AP article that appeared on their wires this morning, but I know that I received a letter from state authorities/ADAP telling me not to do any switching around on my own until I received another letter from them.  I may have gotten the letter now, as I have a huge stack of mail I've procrastinated opening for the past week, so if I find something later I'll share it.  I'm currently with Humana so it looks like I'm in imminent danger from all of this BS.

Just wondering what others have encountered that are in similar situations.  I'm always a bit weary about this overly complex program, and much preferred it when everything was just simply covered by ADAP.

I only included part of the article, the rest of it can be seen by clicking here.

Quote
Changes ahead for Medicare drug program
By KEVIN FREKING, Associated Press Writer
Sat Nov 3, 7:41 AM ET
Nearly 2 million low-income Medicare participants could be switched to different insurance plans for their prescription drug coverage next year.

Millions more will have to shop around if they want to avoid double-digit increases in their monthly premiums.

The reassignment of the poorest beneficiaries and the higher premiums for many others are just two reasons why seniors and the disabled may want to look into other plans as the Medicare drug benefit enters its third year.

The shopping season officially begins Nov. 15 ó the first day of an open enrollment period that continues through Dec. 31.

Advocacy groups warn the benefit's 24.5 million participants to take nothing for granted even if they're happy with their current coverage.

"Everybody needs to shop around every year," said Patricia Nemore, senior policy attorney at the Center for Medicare Advocacy. "Just because you like your plan this year doesn't mean that plan will work the same next year."

Under the drug benefit, Medicare subsidizes insurance plans that cover an enrollee's prescription drug buys. The government pays insurers extra for covering the very poor.

The plans adjust their coverage to reflect the changing marketplace. They change which drugs they will cover for safety and financial reasons. They also make adjustments to the monthly premiums they charge customers, trying to maximize demand for their product and profitability.

On average, Medicare Part D plans will charge a monthly premium of $28 in 2008, but the premiums vary widely across the nearly 1,800 plans around the country. The premiums range from $9.80 for a basic benefit to $107.50 for enhanced coverage.

About a quarter of the poorest beneficiaries don't pay any monthly premium. They will still be entitled to that extra benefit next year, but they will have to get their coverage though other plans meeting Medicare's requirements for offering coverage to low-income beneficiaries. Medicare officials sent letters this past week to nearly 2 million people to inform them that they will be moved to a new plan.

Kerry Weems, administrator for the Centers for Medicare and Medicaid Services, said those beneficiaries can opt to stay with their current coverage if they like, but would have to start paying. He anticipates that the government will make changes to the drug benefit in future years to reduce the number of people "pingponging" from insurer to insurer with each new year of coverage.

"It's not good for them," Weems said. "There's some things we could have done this year to avoid that, but it would have meant changing the business rules after companies had bid. That didn't seem like the right thing to do."

Most of the low-income beneficiaries being reassigned participate in plans offered through UnitedHealthcare and Humana, according to an analysis from Avalere Health, a consulting firm based in Washington. Two companies, Silverscript and Medco, should pick up many of the reassignments.
« Last Edit: November 03, 2007, 02:02:27 PM by philly267 »
"Iíve slept with enough men to know that Iím not gay"

Offline bear60

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #1 on: November 03, 2007, 04:50:11 PM »
David
Seems as tho Kurt got something in the mail that has upset him a lot...sounds similar.
Poz Bear Type in Philadelphia

Offline Queen Tokelove

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #2 on: November 03, 2007, 05:13:59 PM »
I haven't received anything in the mail but I will keep an eye out...
Started Atripla/Ziagen on 9/13/07.
10/31/07 CD4-265 VL- undetectable
2/6/08 CD4- 401 VL- undetectable
5/7/08 CD4- 705 VL- undetectable
6/4/08 CD4- 775 VL- undetectable
8/6/08 CD4- 805 VL- undetectable
11/13/08 CD4- 774 VL--undetectable
2/4/09  CD4- 484  VL- 18,000 (2 months off meds)
3/3/09---Starting Back on Meds---
4/27/09 CD4- 664 VL-- undetectable
6/17/09 CD4- 438 VL- 439
8/09 CD4- 404 VL- 1,600
01-22-10-- CD4- 525 VL- 59,000
Cherish the simple things life has to offer

The Royal Blog

Offline Miss Philicia

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #3 on: November 03, 2007, 05:21:44 PM »
Stuff like this gives me panic attacks.  Anything that threatens my meds just gets me very riled up, plus I'm supposed to be switching to a new med any day now and it's not yet been added to PA's ADAP formulary -- I just tried calling their offices to complain on Friday and nobody would answer their phones.  I know it will be worked out in the end, but when this Part D stuff first began at the end of '05 I was given VERY incorrect information from my case manager, which then caused me to have to cough up money every month that I learned later I should  not even have to be paying -- hence making me more poor than I need to be when my money is already tight.

I have a local support group meeting Monday night so I'll see what the people there have encountered.  The moderator is the co-chair for Philadelphia's Ryan White committee so hopefully he'll know.  He always knows everything! :)
"Iíve slept with enough men to know that Iím not gay"

Online BT65

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #4 on: November 03, 2007, 07:59:53 PM »
I'm not on Humana, but I am on the AARP plan.  I got a letter saying that I will have to start paying co-pays on the medicines, which I did not have to pay previously to this.  The co-pays start next year, btw.  It seems as though another "great government idea" is hitting the skids maybe.
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline Queen Tokelove

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #5 on: November 03, 2007, 08:05:34 PM »
If you're on Medicare, you're not suppose to be paying co-pays? Or am I misunderstanding something?
Started Atripla/Ziagen on 9/13/07.
10/31/07 CD4-265 VL- undetectable
2/6/08 CD4- 401 VL- undetectable
5/7/08 CD4- 705 VL- undetectable
6/4/08 CD4- 775 VL- undetectable
8/6/08 CD4- 805 VL- undetectable
11/13/08 CD4- 774 VL--undetectable
2/4/09  CD4- 484  VL- 18,000 (2 months off meds)
3/3/09---Starting Back on Meds---
4/27/09 CD4- 664 VL-- undetectable
6/17/09 CD4- 438 VL- 439
8/09 CD4- 404 VL- 1,600
01-22-10-- CD4- 525 VL- 59,000
Cherish the simple things life has to offer

The Royal Blog

Offline Miss Philicia

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #6 on: November 03, 2007, 08:37:05 PM »
Betty and Queen, as far as I know the issue of co-pays is a local state issue in terms of how/what ADAP picks up.  Federal law stipulates that ADAP/Ryan White must be the "payer of last resort" so once Medicare Pt. D (i.e. whatever insurance company you have handling your Pt. D coverage) pays out, ADAP can (depending on state) pick up your co-pay.  I know that's how it works in both NY and PA.

Betty, was your letter from the AARP insurer or ADAP?

ps:  to others dropping in here PLEASE keep in mind this issue varies state by state, so ALWAYS get the information from your case manager.  AND do an end run around them afterwards and verify that what they told you is correct by talking to someone else with HIV in your state in the same situation.  Often case managers are as clueless about this issue as we are... sad, but that's what I've seen more than once.
"Iíve slept with enough men to know that Iím not gay"

Offline ademas

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #7 on: November 03, 2007, 09:30:48 PM »
I'm always a bit weary about this overly complex program...


fuck yeah (pardon my french).

I attempted to enroll in a PDP year one, and it turned out to be a nightmare for nearly the entire year.  Countless hours on the phone in conference calls with my caseworker, VP of enrollment at the PDP, and my secondary insurance case manager, and we still never got it all straightened out.  Medicare said I was enrolled, and the PDP said I was enrolled, but all claims were denied by Medicare due to an "electronic signature error", which we never did figure out--particularly since I didn't enroll electronically.  I filed grievance after grievance with Medicare, and they always opened a case and said I would be contacted, but no one ever called, and nothing was ever sent.

The state and my caseworker finally threw in the towel and gave me a pass (a letter of creditable coverage), and allowed me to continue under the old plan without enrollment in a PDP.

That's about to change, though.  I got the letter saying the old plan will be discontinued 01/01/08, and therefore PDP enrollment will be mandatory.

So, here we go again. 

If I can't get it straightened out this time, I'll be out of meds (and out of luck) as of 01/20/08 (I counted my meds out last night, and that's how much I have left).

I know it's not the exactly what you're talking about here, but I can sure relate to the panic.

« Last Edit: November 03, 2007, 09:32:24 PM by ademas »

Offline AlanBama

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #8 on: November 05, 2007, 07:47:46 PM »
Those of us in Alabama's ADAP / Medcap programs have not yet been told which Part D plan to enroll with for 2008.   Currently, we are with Sierra RX and it has not been so good...

I'm with you, philly, stuff like this just makes me a nervous wreck.   How I long for the days when I had good insurance, and didn't worry about things so much.

I do know this:  whatever they do will require a ton of paperwork.   We've already been told to request our Social Security denial letter for "extra help" with Part D, and I have done that online.  They will probably require another Medicaid denial letter as well.....hmmm, weren't eligible last year, nothing has changed....sort of seems like common sense would tell you that we're not eligible this year....but wait, common sense doesn't apply anywhere when you're dealing with "the system".

 :-\
« Last Edit: November 05, 2007, 07:51:36 PM by AlanBama »
"Remember my sentimental friend that a heart is not judged by how much you love, but by how much you are loved by others." - The Wizard of Oz

Offline Queen Tokelove

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #9 on: November 05, 2007, 09:39:13 PM »
I got the letter today but damn, I am suppose to call all these numbers.... ???
Started Atripla/Ziagen on 9/13/07.
10/31/07 CD4-265 VL- undetectable
2/6/08 CD4- 401 VL- undetectable
5/7/08 CD4- 705 VL- undetectable
6/4/08 CD4- 775 VL- undetectable
8/6/08 CD4- 805 VL- undetectable
11/13/08 CD4- 774 VL--undetectable
2/4/09  CD4- 484  VL- 18,000 (2 months off meds)
3/3/09---Starting Back on Meds---
4/27/09 CD4- 664 VL-- undetectable
6/17/09 CD4- 438 VL- 439
8/09 CD4- 404 VL- 1,600
01-22-10-- CD4- 525 VL- 59,000
Cherish the simple things life has to offer

The Royal Blog

Offline leatherman

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #10 on: November 05, 2007, 11:30:15 PM »
I got a letter saying that I will have to start paying co-pays on the medicines, which I did not have to pay previously to this.  The co-pays start next year, btw.  It seems as though another "great government idea" is hitting the skids maybe.

No maybe about it. Things changed in Ohio last year and although I have medicare and medicaid I started paying co-pays. It may only be $14 per month for my meds now; but it's $14 I didn't have to pay previously.

Although there is a limit on how much I have to pay before anything else kicks in (PDP, medicaid) and totally covers the costs. So I end up paying a co-pay of $14 a month for the first 5 months of the year, before getting the rest of the year's meds with no out-of-pocket costs. So the grand "medicare part d" scheme costs me about one month's worth of SSD per yr.

And it happens worse to some people. An older friend of mine, with lung problems,  now has a co-pay of $300 per month when he had $0 out-of-pocket costs previously. That's after having a case worker intercede for him too. I think he paid out nearly $500 the first month to keep getting his meds.

I know it's not the exactly what you're talking about here, but I can sure relate to the panic.
I have to admit I kinda keep my head buried the sand over these issues. Way back in 98 when I first went onto disability (PCP, <200), I very nearly died then and a few times more times over the next 5 yrs. I did whatever they asked me to so I could get the meds and get better. As I did get better, and out-lived what the gov't thought I should, I've tried to stay "low and under the radar". I used to bitch about the endless paperwork (they have 14 copies of my birth certif and driver lic now); but I'll do whatever is required to stay eligible for the meds. Luckily, besides a once a yr meeting with the state welfare dpt to verify things, this $14 payment is the only thing that's changed with my case now in the past 5 yrs. I'm sure the bottom will fall out one day.  ::)

mikie
(who probably should read the "book" SS just mailed to me titled "Medicare & You 2008"  :D )
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Online BT65

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #11 on: November 06, 2007, 07:04:56 AM »
Philly, sorry it's taken me so long to get back to your question.  The letter I got was from the AARP.  I'm going to contact my case manager at the local ASO and see what, if anything, can be done about the co-pays.  It's money that I don't have, as I'm sure we all don't. 
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline Queen Tokelove

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #12 on: November 06, 2007, 01:19:49 PM »
I got with my case manager today and she is going to get me into the SPBP program, Philly. There is also something she can do on her computer to pick out the best plan for me as far as Medicare goes and sees if it will  cover all of my other meds....If so, she will let me know and we will go from there....
Started Atripla/Ziagen on 9/13/07.
10/31/07 CD4-265 VL- undetectable
2/6/08 CD4- 401 VL- undetectable
5/7/08 CD4- 705 VL- undetectable
6/4/08 CD4- 775 VL- undetectable
8/6/08 CD4- 805 VL- undetectable
11/13/08 CD4- 774 VL--undetectable
2/4/09  CD4- 484  VL- 18,000 (2 months off meds)
3/3/09---Starting Back on Meds---
4/27/09 CD4- 664 VL-- undetectable
6/17/09 CD4- 438 VL- 439
8/09 CD4- 404 VL- 1,600
01-22-10-- CD4- 525 VL- 59,000
Cherish the simple things life has to offer

The Royal Blog

Offline perspiry

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #13 on: November 06, 2007, 01:53:15 PM »
You mean I have to read all that crap from Medicare as well as Tenet??  Both hefty envelopes came last week and last night I pored over Tenet's materials since they cover me for everything.

A few copays are increasing but my copay for a month's supply of Trizivir is still $25, a slight savings of $1375 over out-of-pocket.   The copay for most HIV drugs is $25 and a few generics are $5.  My PCP visits are still $5 and my psych visits still $10 -- references to specialists went from $10 to $15 but I haven't seen a specialist in years.

I live in one of the most benighted states in the country so find it hard to believe I'm getting off so easily.  I'll probably have to take a full dose of amitriptyline tonight to deal with the anxiety.  Thanks a lot, philly...

JA

If I'd been thinking I would have chosen Tangina as my forum moniker.

Offline Miss Philicia

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #14 on: November 06, 2007, 04:27:20 PM »
I got with my case manager today and she is going to get me into the SPBP program, Philly. There is also something she can do on her computer to pick out the best plan for me as far as Medicare goes and sees if it will  cover all of my other meds....If so, she will let me know and we will go from there....

Ah, good for you hun.  I feel better that you're getting what you're eligible for here in PA now that you've joined the lofty HIV med taking club :)

I had my support group last night and none of the other queens knew anything about these Pt. D changes so I guess if I can't figure it out on my own I'll go pester my case manager.
"Iíve slept with enough men to know that Iím not gay"

Offline ademas

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #15 on: November 06, 2007, 06:30:58 PM »
I've been working on this stuff all day.
I tell ya, it just fries my brain.
The PDP I enrolled in before is no longer, and they've splintered it into 3 PDP programs with different tiers of coverage.
You would think the caseworkers would know this by now (particularly since they pay the part D monthly premium, and the premium varies significantly between plans), but they didn't know, and they had no suggestion as to which tier of coverage I should select.
I know it's probably unrealistic, but I just want someone to tell me what to do at this point, you know?  Even a "most of our clients are doing this, and it seems to be working out well" would  be helpful.



Offline SteveA

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #16 on: November 07, 2007, 02:36:50 AM »
Good Grief! Not again!  ??? It took them 11 of the first 12 months to get me into the correct program the first year as well! No wonder I've been feeling a headache for the past few days! Oh and apparently even though I'm covered this year, for some reason AARP keeps kicking back the full price for my new diabetes testing supplies!

Online BT65

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #17 on: November 10, 2007, 08:17:17 AM »
I've contacted my ASO and the worker there said to bring in the letter that I got from AARP about the increase in co-pays.  She (the worker at the ASO) said that I should be able to get on another plan where I wouldn't have to pay any co-pays.  Of course, now I can't find the letter.  So I called AARP, they told me to call Medicare, who told me to call Social Security directly.  Then Social Security sent me back to AARP.  Finally someone at AARP knew what I was talking about and they have another letter en route.  Nothing like being shuffled between government agencies, each one saying the other one is responsible.  Anyway, hopefully I can get this mess straightened out before December. 

And Steve, I get my diabetic testing supplies from a local pharmacy who writes off what Medicare doesn't cover.  It seems like there should be something like that close to you.  Mine is a home delivery pharmacy.  Check around.  You shouldn't have to be paying anything for that.
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline Miss Philicia

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #18 on: November 10, 2007, 09:57:14 AM »
Well, it seems the authorities here in Pennsylvania via the SPBP offices in Harrisburg (what we call ADAP here) have indicated to me during a phone call on Thursday that they will be co-ordinating the change of Pt. D insurance coverage in a forthcoming letter.

I've been playing around with Medicare's web site yesterday and this morning -- such a monstrosity.  I had to do a "live help" session with one of their personnel just to get my username and password to work correctly.  I pity the 80 year old that has to endure all of this, much less some AIDS inflected individual sick in bed.

I'm afraid to even call my case manager after she screwed me when I originally signed up for Medicare Pt. D -- to the tune of a wasted +$1200 over the past 2 years that, from what I've learned from others locally, I should not have had to pay as a premium.  No wonder I could not attend AMG! (plus another +$720 I pay for something not on our formulary, but was on the formulary in New York.

It's all a bit of madness -- when it was just straight ADAP we had NONE of this foolishness.  I guess this is all due to Dumbyafuckleberry's grand idea which, like everything he touches, implodes.  I just don't get it all.

Hopefully Hillary will save us all! :)
"Iíve slept with enough men to know that Iím not gay"

Offline Robert

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #19 on: November 10, 2007, 11:42:52 AM »
Anything SSDI/Medicare/ADAP just scares the bejesus out of me and I am relative cogent.  I have lost a lot of my marbles though and tend to get confused easily so reading whats been posted here just really bothers me.

I've mentioned before I have an ancillary plan with Kaiser to go along with my Medicare.  One good thing about it is that they have their own counselors and I don't have to go through any ASO.  Here in California you have to re-up your ADAP eligibility 60 days prior to your birthday and my birthday is coming up in December.  I have an appointment with my Kaiser counselor in a couple of weeks and I hope it goes smoothly.  Kaiser has been pretty good with coupling ADAP and Medicare (particularly Part D) so I hope it's not too traumatic.  Like I said, in my current state of mind, you gotta keep things simple.

robert
..........

Offline SteveA

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #20 on: November 10, 2007, 02:56:28 PM »
I've contacted my ASO and the worker there said to bring in the letter that I got from AARP about the increase in co-pays.  She (the worker at the ASO) said that I should be able to get on another plan where I wouldn't have to pay any co-pays.  Of course, now I can't find the letter.  So I called AARP, they told me to call Medicare, who told me to call Social Security directly.  Then Social Security sent me back to AARP.  Finally someone at AARP knew what I was talking about and they have another letter en route.  Nothing like being shuffled between government agencies, each one saying the other one is responsible.  Anyway, hopefully I can get this mess straightened out before December. 

And Steve, I get my diabetic testing supplies from a local pharmacy who writes off what Medicare doesn't cover.  It seems like there should be something like that close to you.  Mine is a home delivery pharmacy.  Check around.  You shouldn't have to be paying anything for that.

I called Medicare directly and they told me basically that "Walgreen's Pharmacy's" SUCK! They don't have proper Medicare accounts set up and go on case by case basis for each and every claim which screws things up royally. They recommended 3 different local outfits, one of which was just 5 blocks from home so I went there with a new script from my Doctor and they gave me a whole different tester with test strips that don't cost an arm and a leg for nothing. The new tester isn't as fast as the FreeStyle tester my doctor gave me 120 seconds for results instead of 5 seconds, but the test strips are only $35 as opposed to $104 for a month's supply so even if Medicare has problems paying for them for a month they're not as expensive as the others.

Offline Miss Philicia

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #21 on: December 06, 2007, 12:13:23 AM »
Well, after nearly a month I've YET to receive the promised letter communication from the dipshits in charge of this dumb ADAP/Medicare Pt. D program, so Monday I called them.  Ends up they told me they mailed me a letter, but when I insisted they tell me the date it went out they said 13 December -- I bitch please, that was that very Monday.   How DO these people keep their jobs?

So today I called once again (different person took my call of course) and she seemed to think they'd assigned me to the appropriate thing, but when I told her how much monthly I've paid for the past year and half for my HIV meds (previous to 8/06 I'd paid nothing) she said that I shouldn't have paid anything, and it seemed like Humana has been double dipping -- billing me AND the state authorities for the same policy.

SOOOOOOOOOOO... it just may very well be the case (I did I concise spreadsheet to send them) that I'm now due $921.84 :))))))

Now, what SHOULD I buy myself?
"Iíve slept with enough men to know that Iím not gay"

Offline thunter34

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #22 on: December 06, 2007, 12:26:18 AM »
SOOOOOOOOOOO... it just may very well be the case (I did I concise spreadsheet to send them) that I'm now due $921.84 :))))))

Now, what SHOULD I buy myself?

Tis better to give than to receive, ya know.  So the better question is what SHOULD you buy me?   ;D

But back to topic...I stood in line at the CVS yesterday behind an elderly couple as they learned that they were "in the gap" with this part D business and their medicine bill was about $580 dollars.  These were obviously much needed medicines (at least one I know was for diabetes and another for heart medication).  The elderly woman was visibly shaken and burst out in anger momentarily, but that gave way quickly to sobbing.  She had to sit down in the little pharmacy chair while her husband tried to console her.  He was trying to come up with some sort of financial game plan to come up with the money and...I dunno...eat, I imagine - or pay for heat or who knows what.  She was just crying, "how are we going to do this?"  The lady at the counter was telling them that she wished she knew something to do, and that she hated to see it because she knew one day it was going to be her in the same situation.

That's really all I've got here...just this little anecdotal incident that I witnessed yesterday.  It just really had an impact on me, seeing this frail little old couple so paniced and all. 
AIDS isn't for sissies.

Offline Miss Philicia

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #23 on: December 06, 2007, 02:13:01 AM »
I suppose I could go to Amsterdam with this money, but something tells me I'll spend it on shoes.
"Iíve slept with enough men to know that Iím not gay"

Offline Miss Philicia

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #24 on: December 07, 2007, 04:44:19 PM »
Well, now I finally received the long promised letter that was due in early November on December 6th.  I called again and this time spoke to a supervisor, and of course she contradicted her underling and stated that it's hardly possible that I will receive a full reimbursement for the $921.84 I've paid unnecessarily in Medicare Pt. D premium payments for the past 18 months.  Fuckers.  I bet at the end of the day they'll send me a check for $75 or something.  Mind you,l this doesn't even include the $1187.64 I've paid for the past 3 years for my anti-anxiety medication.  Now someone tell me why anti-depressants are included on ADAP but not anti-anxiety meds -- they were in New York.  You know, I moved here to Philadelphia to save money on stuff like rent, but frankly I'm beginning to wonder if I'm spending more money here.  Can you tell I'm rather livid?  Yes!  I sure as fuck am.  I think it may even be time for a glass of bourbon on ice.

So I spent all last night going through my rather messy box of medical paperwork (is it filed at all?  Nooooooo... used to be but I gave up on all that after a decade of my fun virus.  Then I put together a spreadsheet for Miss Supervisor at whatever third party corporation PA state ADAP farmed out their inept services too because the real state office is basically staffed by a total of 3 people.  The head of it's an old queen and after all of this is settled that sodomite is going to get a testy, sharply worded letter from yours truly.  Maybe he'll offer me a job :)  ha ha  (NOT)

Oh, and then Miss Supervisor gave me the wrong email address to send my letter and various documentations (which involved much scanning and resizing of documents... *sigh*) so I spent hours and hours until 2 am wondering why everything kept getting returned to me as undeliverable.   Ugh... so I finally sorted out her real address and seemingly nothing has been returned in my email program.  I'm sure she'll end up saying 2 weeks from now that she never received it.

You know, this has been my life for the past six years.  All of these bureaucratic staffers for these indigent programs I firmly believe are all on barbiturates or something.

On the up side, they co-ordinated moving me to a new Medicare Pt. D insurer effective 1/1/08 and I won't have to pay anything for it... too bad they didn't do this a year ago.  Oddly they did all of this without me having to sign a document so in the back of my mind I still think surely they must have fucked something up and I'll find out about when I go in for med refills in January.
"Iíve slept with enough men to know that Iím not gay"

Offline Miss Philicia

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #25 on: December 08, 2007, 09:13:44 AM »
Am I the only one having issues with all of this crap?  Nobody seems to have given any feedback so I'm just wondering if this is all part of the Santeria curse(s) that were placed on me in the late 90's -- yes indeed, never screw over a Puerto Rican fag that's into that kind of stuff or you will live to regret it.

Anywho -- I'm on this email mailing list from POZhealth@yahoogroups and I'm doing an ole copypasta as it's relevant to this thread:

Medicare Part D enrollment snafu
Posted by: "John R." xxxxxxxxxx@yahoo.com 
Fri Dec 7, 2007 11:41 pm (PST)

A word of warning to anyone changing their Medicare Part D plan for 2008: be sure to verify one week after enrollment that the plan you have enrolled in, either online or through the 800 MEDICARE number, has received your application and is processing your enrollment.

I enrolled in a new plan for 2008 online on 11/21, and received a confirmation number and a message congratulating me on my successful enrollment. Two weeks later, attempting to complete an application for my ADAP program, I called the plan to verify enrollment, and they had no record of my enrollment. Neither did they have any record of my enrollment at the 800 MEDICARE number in their automated system or when I spoke to a live operator. I had the live operator re-process my enrollment, and received a new confirmation number. Needless to say, I made sure to write down the name of the live operator, and will call the plan in one week to confirm enrollment.

With the enrollment deadline approaching on 12/31, it's a good idea for anyone who has been procrastinating to enroll ASAP to allow time for verification and re-enrollment if necessary.

My Walgreens pharmacy was able to help me select a plan by printing out a list of plans that cover all of my drugs. I think they will do this even for non-customers, although you'd probably have to give them a list of your medications and doses. This made choosing a plan relatively easy, using Medicare's online plan information. If you're not comfortable using the online tools yourself, the 800 MEDICARE operators can help, as can any internet-savvy friend. Be sure to have all of your prescription bottles handy so you can type the names and doses of all of your medications into the online planning tool.
"Iíve slept with enough men to know that Iím not gay"

Offline Grinch

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #26 on: December 08, 2007, 10:26:59 AM »
Government run health care FTW

Dan J.

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #27 on: December 08, 2007, 10:32:25 AM »
I asked my case worker how do I know I am on the right Part-D plan? She told me to ask my pharmacist. He told me not to switch plans on my own that I would "fall through a cracks" and might not get my meds for one month.  So I left it alone... I am on the AARP program which is managed by Humana. You can apply for extra help to pay your Medicare Premiiums & drug co-pays through Social Security.

Dan

Offline Miss Philicia

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #28 on: December 08, 2007, 10:36:00 AM »
Government run health care FTW

Uh, actually the folks messing it up are the 3rd party commercial entity that the government outsourced the services to.

But nice try.
"Iíve slept with enough men to know that Iím not gay"

Offline Miss Philicia

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #29 on: December 08, 2007, 10:39:08 AM »
I asked my case worker how do I know I am on the right Part-D plan? She told me to ask my pharmacist. He told me not to switch plans on my own that I would "fall through a cracks" and might not get my meds for one month.  So I left it alone... I am on the AARP program which is managed by Humana. You can apply for extra help to pay your Medicare Premiiums & drug co-pays through Social Security.

Dan

I've been on Humana myself, but evidently at least here their rates are going up by something like 70% so they're switching me to Silverscript (never heard of them).  And of course since I'm on the most expensive HIV meds out there I guess that comes into play.

It's all horribly odd -- everything was better when it was ALL just done by SPBP.  We now have Dubya to thank for this mess of Medicare Pt. D, because it's not handled by the government but outsourced to private insurers.  When I have my medical/lab stuff done it's directly handled by Medicare and there's NEVER an issue.
"Iíve slept with enough men to know that Iím not gay"

Offline gerry

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #30 on: December 08, 2007, 11:44:33 AM »
Unfortunately, this was a predictable outcome for folks with very high prescription drug costs when the new law specifically prohibited Medicare from negotiating drug prices from the pharmaceutical companies (which was a huge win for the pharma lobbies).  In effect, it relegated drug price negotiations down to what current private insurance companies go through (via pharmacy benefit managers) which obviously does not have the same bargaining strength as what Medicare would have been able to wield.

Offline Robert

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Re: Changes ahead for Medicare Pt. D drug program
« Reply #31 on: December 08, 2007, 11:53:34 AM »
philly.

LIke I've said before, this kind of stuff just really bothers me.  When I read about your phone calls and spreadsheets then I really started shaking.  I just can't handle that stuff anymore.  Here in California we have to re-up our ADAP every year on our birthday.  (My birthday is in a couple of weeks) I told you I'm on Kaiser.  In Oct I got an email from my ADAP contact at Kaiser to make an appointment and fill out the forms.   Kaiser also handles my Medicare including Part D through their Senior Advantage program.  Every month they send me a statement noting how much has been paid on Part D by me and/or outside sources.  I haven't paid a dime.  I have no co-pay. 

I haven't heard from Kaiser about any changes for next year and being afraid of rocking the boat, I'm just assuming there are no changes and it's business as usual.  This sort of thinking usually gets me in trouble.

robert 
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