I Hate Dialysis Message Board

Dialysis Discussion => Dialysis: Medicare/Insurance => Topic started by: Cupcake on August 04, 2019, 07:22:38 AM

Title: Medicare OptumRx
Post by: Cupcake on August 04, 2019, 07:22:38 AM
Excuse me if this has been discussed before and I missed it. I had to transition to a medigap plan as my Cobra ran out 8 months post transplant. I picked medicare part D and part F-I was advised by the specialty pharmacy that mails me my meds to avoid any Medicare Advantage HMO's as they are harder to get things covered.

Has anyone any experience with the mail order plan from Part D OptumRx? It gets horrible reviews online-multiple complaints of hard to get refills, they run out of meds, customer service has language barriers, etc etc. I was thinking of just using my local Walgreens which is listed as preferred; any experience using a local pharmacy and not a specialty pharmacy?

Am I right in thinking that Part B is covering my transplant meds? I haven't paid a dime for meds since my transplant so I am spoiled.

Thanks much.
Title: Re: Medicare OptumRx
Post by: SooMK on August 04, 2019, 01:22:40 PM
I'm assuming you are over 65 so you are eligible for Medicare because of age?  I don't know what the rules are if you are under 65 and are covered under Medicare because of ESKD and not age. I had my transplant 5 years ago just after I turned 65. All my anti-rejection meds continue to be covered by Medicare Part B. I chose Plan F for my Supplemental with AARP/United Health Care. I also read that the Advantage plans were not the best choice for kidney patients. Although I don't use OptumRx, it is the Mail Order Plan that my Part D (AARP/UHC) offers and pushes. I review the options for Part D plans every year and have switched Part D plans 3 times. Last year I decided to go with United Health Care for Part D because I have been so satisfied with their Supplemental Plan. I use a specialty pharmacy for my anti-rejection meds. They send my drugs to me via UPS and they have been fantastic. I hope I never have to switch away from them as they are so dependable. Before I switched to UHC I used Humana's mail order for several of my other drugs because I assumed I was saving money and because they really push the service. However, in doing my research for this last switch it didn't look to me like I was actually saving any money. So now I use the specialty pharmacy for my anti-rejection meds and anything else I get through my local pharmacy. Since you have to go to your local pharmacy for any short term medications anyway, I don't really see the benefit of any mail order plan.

There has been some reports of a shortage of tacrolimus. I called my specialty pharmacy to ask them about it and they said they had anticipated it and had ordered extra so there was no reason to be concerned. I think this might be the advantage of a specialty pharmacy. The one I use is the same one the hospital uses so they are ordering a lot of these drugs and have a lot of experience with them. That may not be the case with a local pharmacy.

Title: Re: Medicare OptumRx
Post by: Cupcake on August 05, 2019, 08:58:07 AM
Thanks so much! I feel better, that's exactly what I did with United thru AARP. Plan F and D

Now what specialty pharmacy do you use for transplant meds?
Title: Re: Medicare OptumRx
Post by: SooMK on August 06, 2019, 03:33:06 PM
I use TotalCareRX in NYC. They provided my meds in the hospital (New York Presbyterian) and I was told I could continue to use them so that's what I did. They send me a text reminder every month and I can text my order back to them. They take care of getting the scripts renewed (for the anti-rejection meds). They have been fabulous.

Title: Re: Medicare OptumRx
Post by: iolaire on August 06, 2019, 03:47:08 PM
Are any of you able to get 3 month supplies of transplant meds?

Update: on dialysis the Aetna online pharmacy and specialty pharmacy pushed 3 - months supplies, so for example when I was receiving Zemplar (paricalcitol) prescriptions those were for three months despite being a costly medicine.  I've not yet asked for three month supplies but it seems to make sense.  I  wonder if insurance versus Medicare has different rules?
Title: Re: Medicare OptumRx
Post by: SooMK on August 07, 2019, 07:59:00 AM
Not me. I worry about natural disasters and all the many reasons I might not be able to get my meds but over the 5 years I've built up a bit of a cache except for my .5 mg Tacrolimus. I wonder what I would do if I couldn't get more for awhile. Try to halve the 1 mg? I'm pretty sure you're not supposed to do that.

I couldn't even get my neph to give me a 90 day supply of Vit D (3 pills). Every month I get a bottle with one little pill in it. As if there isn't enough waste involved with chronic illness.
Title: Re: Medicare OptumRx
Post by: Alexysis on August 11, 2019, 08:55:36 AM
First of all, you are confusing things here: it's Medicare part D, and Medigap TYPE F. The PartD is the drug coverage. go to the Medicare webpage, and they have a part D policy finder which will tell you which plan gives the best deal depending on your medications. As for the Medi GAP policy, if you are having a chronic disease, the TYPE F is really the only way to go. Advantage plans are designed for people who are otherwise healthy. With a chronic condition, you'll end up paying much more on an advantage plan.