What do you think about Medicare Part D (SilverScript SmartSaver (PDP) ) premium/copay raising ?

[RIMDBogle]

What do you think about Medicare Part D (SilverScript SmartSaver (PDP) ) premium/copay raising ?
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Thanks for replies to my threads.


I learned that law passed law to lower premium /drug cost for medicare participants and received an email from Aetna that said:

Here’s a quick glance at your 2023 SilverScript SmartSaver (PDP) plan:


Select Insulins are not subject to a deductible and are now available at preferred pharmacies for $10 copay. And $20 copay at other network pharmacies. In addition many brand anti-diabetic drugs have been moved down to Tier 2.

We’ve reduced the cost share for 490 drugs by moving them from higher tiers down to Tier 1 and 2 drugs.

Your Tier 2 copay is now $15 at preferred pharmacies, reduced from $19 in 2022*. And your Tier 1 copay is $2 at preferred pharmacies.

You continue to have 24,000 preferred pharmacies to choose from in a network of 44,000 pharmacies.
Your SilverScript SmartSaver (PDP) plan will continue to offer you $0 deductible on Tier 1 drugs.

I went to fill my RX at pharmacy in 2023 and learned that my copay doubled for tier 1 drugs like Metformin. My premium also gone up.

I called Aetna PDP Customer care. They told me the above raise was from direction from Medicare.

I called Medicare, who said they have nothing to do with Part D premium/copay raise.

I am in a dilemma, why email says one thing, but experiencing a different street reality.

Anyone from this forum experience the same ?

How/where can I raise my concern ?

Thanks for sharing.

[Silentnight]

Last year's premium, for me in my State, was $6.80. This year's premium is $4.80. In 2022 my script cost $1, in 2023 it costs $2. I was paying $10 for the script when working.

[cashmoney]

What do you think about Medicare Part D (SilverScript SmartSaver (PDP) ) premium/copay raising ?
==================================================================================

Thanks for replies to my threads.


I learned that law passed law to lower premium /drug cost for medicare participants and received an email from Aetna that said:

Here’s a quick glance at your 2023 SilverScript SmartSaver (PDP) plan:


Select Insulins are not subject to a deductible and are now available at preferred pharmacies for $10 copay. And $20 copay at other network pharmacies. In addition many brand anti-diabetic drugs have been moved down to Tier 2.

We’ve reduced the cost share for 490 drugs by moving them from higher tiers down to Tier 1 and 2 drugs.

Your Tier 2 copay is now $15 at preferred pharmacies, reduced from $19 in 2022*. And your Tier 1 copay is $2 at preferred pharmacies.

You continue to have 24,000 preferred pharmacies to choose from in a network of 44,000 pharmacies.
Your SilverScript SmartSaver (PDP) plan will continue to offer you $0 deductible on Tier 1 drugs.

I went to fill my RX at pharmacy in 2023 and learned that my copay doubled for tier 1 drugs like Metformin. My premium also gone up.

I called Aetna PDP Customer care. They told me the above raise was from direction from Medicare.

I called Medicare, who said they have nothing to do with Part D premium/copay raise.

I am in a dilemma, why email says one thing, but experiencing a different street reality.

Anyone from this forum experience the same ?

How/where can I raise my concern ?

Thanks for sharing.

Silver Scripts has to get plan benefits approved by CMS/Medicare each year and send members an Annual Notice of Change ( ANOC) that shows changes from 2022 to 2023 by the end of September. Also when you first enroll the fact that plans can change or not renew contract is in the Statement of Understanding on the application and also in the Summary of Benefits provided

If you have the Silver Script Saver PDP the tier 1 copayment should be 2.00 or less.


licensed agent

[celia]

What do you think about Medicare Part D (SilverScript SmartSaver (PDP) ) premium/copay raising ?

Each year, the drug plans are allowed to change:
* premiums
* tiers for each medicine
* re-negotiate with manufacturers
* set co-pays for each medicine which impacts each phase (deductible, initial, coverage gap/donut hole, catastrophic) you are in as you go through the year.
* contract with which pharmacies are”preferred”

During the Oct to Dec Open Enrollment, you are encouraged to run your current meds through Medicare’s drug tool to see which plan in your area has the overall lowest cost (premiums plus your co-pays). Then if you find a lower cost plan, you can easily change to that plan.

Did you do the comparison last year for 2023? (You can still do the comparison now for you to see your best choices, but you are now locked into your current plan for 2023.)

If you have the Silver Script Saver PDP the tier 2 copayment should be 2.00 or less.

I’m pretty sure the premiums and co-pays can vary by zip code. And the co-pay is also impacted by which phase you are in.

OP also said he received a letter from the drug plan saying:

Your Tier 2 copay is now $15 at preferred pharmacies, reduced from $19 in 2022*. And your Tier 1 copay is $2 at preferred pharmacies.

OP, do you use a “preferred” pharmacy? They can change each year for each drug plan.

[cashmoney]

What do you think about Medicare Part D (SilverScript SmartSaver (PDP) ) premium/copay raising ?

Each year, the drug plans are allowed to change:
* premiums
* tiers for each medicine
* negotiate with manufacturers
* set co-pays for each Med for each phase (deductible, initial, coverage gap/donut hole, catastrophic) you are in as you go through the year.
* contract with which pharmacies are”preferred”

During the Oct to Dec Open Enrollment, you are encouraged to run your current meds through Medicare’s drug tool to see which plan in your area has the overall lowest cost (premiums plus your co-pays). Then if you find a lower cost plan, you can easily change to that plan.

Did you do the comparison last year for 2023? (You can still do the comparison now for you to see your best choices, but you are now locked into your current plan for 2023.)

If you have the Silver Script Saver PDP the tier 2 copayment should be 2.00 or less.

I’m pretty sure the premiums and co-pays can vary by zip code. And the co-pay is also impacted by which phase you are in.

OP also said he received a letter from the drug plan saying:

Your Tier 2 copay is now $15 at preferred pharmacies, reduced from $19 in 2022*. And your Tier 1 copay is $2 at preferred pharmacies.

OP, do use a “preferred” pharmacy? They can change each year for each drug plan.

I am pretty positive tier 1 is 2.00 copayment or less in the initial coverage stage as they have the same benefits in all states for the Silver Scripts Saver Plan however the premiums can vary by state and on average is $ 5.92

https://www.aetnamedicare.com/documents ... 2023_M.pdf

Fun fact about the low premium Silver scripts Saver plan in 2023 that Bogleheads will like is that they no longer pay commissions to agents for marketing this plan.

disclaimer licensed agent

[Bcdkgf]

I too, was a bit perturbed at 100% increase in Tier One. 100% really? Still, over all it is very affordable and I have to count my blessings that I don't have any more severe medical issues.

[tallguy3891]

The cap for some insulins went into effect this year. Insulins can traditionally be very expensive. In 2025 apparently there will be a cap on yearly out of pocket for Rx? Also, I think in the future part of the new law is to negotiate on certain (increasingly for awhile at least) numbers of common meds? My opinion is that companies are not in the business of losing profit so is it possible they will change prices for other meds and increase premiums to make up for these changes?

[michaeljc70]

What do you think about Medicare Part D (SilverScript SmartSaver (PDP) ) premium/copay raising ?
==================================================================================

Thanks for replies to my threads.


I learned that law passed law to lower premium /drug cost for medicare participants and received an email from Aetna that said:

Here’s a quick glance at your 2023 SilverScript SmartSaver (PDP) plan:


Select Insulins are not subject to a deductible and are now available at preferred pharmacies for $10 copay. And $20 copay at other network pharmacies. In addition many brand anti-diabetic drugs have been moved down to Tier 2.

We’ve reduced the cost share for 490 drugs by moving them from higher tiers down to Tier 1 and 2 drugs.

Your Tier 2 copay is now $15 at preferred pharmacies, reduced from $19 in 2022*. And your Tier 1 copay is $2 at preferred pharmacies.

You continue to have 24,000 preferred pharmacies to choose from in a network of 44,000 pharmacies.
Your SilverScript SmartSaver (PDP) plan will continue to offer you $0 deductible on Tier 1 drugs.

I went to fill my RX at pharmacy in 2023 and learned that my copay doubled for tier 1 drugs like Metformin. My premium also gone up.

I called Aetna PDP Customer care. They told me the above raise was from direction from Medicare.

I called Medicare, who said they have nothing to do with Part D premium/copay raise.

I am in a dilemma, why email says one thing, but experiencing a different street reality.

Anyone from this forum experience the same ?

How/where can I raise my concern ?

Thanks for sharing.

When you say your co-pay on metformin doubled, is that like $2 to $4 or $20 to $40? I am not trying to be facetious. It is $2 at Walmart per month with no discount. I pay $38/year for the Kroger Rx savings plan and I get metformin for free. If you are paying a lot for metaformin you can look at discount programs or shop around to get it cheap.