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What are Bonus Drugs and how do they work with my Medicare Part D prescription drugplan?
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Publish On 2009-02-27 , 8:12 PM
Is it possible to have certain prescription drugs that are covered under my Medicare Part D prescription drug plan when these same medications are actually excluded from the Medicare Part D program?
Yes. For most people this question about the coverage of non-Medicare Part D medica ...
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10 Reasons Why You May Be Paying Full Price For Your Medications - 10. No Prescription is on File
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Publish On 2009-02-27 , 5:08 PM
(10) No Prescription is on File - Strange but True - You do not have a prescription for the medication on file with the pharmacy – this is an unusual situation, but possible. We have been working with a Medicare beneficiary who purchased her insulin (Humalin) throughout all of 2006, 2007 ...
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10 Reasons Why You May Be Paying Full Price For Your Medications - 9. Out of Network Purchase
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Publish On 2009-02-27 , 5:07 PM
(9) Out of Network Purchase - You are purchasing your medications at a non-network pharmacy. If no network pharmacy is available, you may be able to get reimbursed for the cost, although the price may still be higher than what you would pay at a network pharmacy. Remember that medi ...
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10 Reasons Why You May Be Paying Full Price For Your Medications - 8. Referenced-Based Pricing
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Publish On 2009-02-27 , 4:53 PM
(8) Referenced-Based Pricing – If you find that your medications are costing much more than you expected, you may find that you are purchasing medications under a Part D plan’s Referenced-Based Pricing policy. Reference-based pricing also falls under the subject of utilization mana ...
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10 Reasons Why You May Be Paying Full Price For Your Medications - 7. No Prior Authorization
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Publish On 2009-02-27 , 4:45 PM
(7) No Prior Authorization - You are purchasing the medications without prior authorization from your Medicare Part D plan. Some medications are carefully monitored by Medicare Part D plans and require that the Medicare beneficiary receives prior authorization from the Part D plan before ...
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10 Reasons Why You May Be Paying Full Price For Your Medications - 6. Quantity Limit Exceeded
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Publish On 2009-02-27 , 4:45 PM
(6) Quantity Limit Exceeded - You have exceeded your monthly quantity limit for a particular medication. If you are using a medication that has a 30/30 quantity limit (30 tablets for 30 days) and have already filled one prescription for the first 30 tablets and now are seeking a refi ...
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10 Reasons Why You May Be Paying Full Price For Your Medications - 5. In the Donut Hole
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Publish On 2009-02-27 , 4:44 PM
(5) In the Donut Hole - You are already in the coverage gap (Donut Hole) and are 100% responsible for the cost of your medications. At this time of year, the chances are slim that you are already in the donut hole unless you have purchased medications with a retail value of over $2,70 ...
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10 Reasons Why You May Be Paying Full Price For Your Medications - 4. Retail Price Less than Co-Payment
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Publish On 2009-02-27 , 4:44 PM
(4) Retail Price Less than Co-Payment - The co-payment for your medication is more than the retail cost of your drug. For example, if you are using a medication that has a retail cost of $58 and the co-payment of the medication is $60, you will always pay the lower cost, or in this example t ...
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10 Reasons Why You May Be Paying Full Price For Your Medications - 3. Non-Covered Prescription
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Publish On 2009-02-27 , 4:43 PM
(3) Non-Covered Prescription - The medication that you just purchased is a non-formulary medication that is not covered by your Medicare Part D plan or has been removed from your formulary. This may be a problem for people who did not change from their 2008 Medicare Part D plan and only now f ...
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10 Reasons Why You May Be Paying Full Price For Your Medications - 2. Still in Initial Deductible
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Publish On 2009-02-27 , 4:42 PM
(2) Still in Initial Deductible - You are in the initial deductible phase of your Medicare Part D plan and are 100% responsible for the full retail cost of your medications until the deductible is met. The standard deductible for 2009 is $295, although Part D plans can use lower deductibles. S ...
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