Medicare-D

Medicare-D

Where does the money come from in Medicare-D?

For example, suppose somebody gets a 3 month supply of various meds, and the
pharmacy claims that the retail price is, say, $180, but the premiums are
$20 per month,

Also assume that co-pays are $0.

So who pays the other $120(180-60)?

I'm thinking of a case in which the Explanation of Benefits states that the
pharmacy was re-imbursed the full $180 by the insurance company, i.e., the
medicare price was the same as the retail price..

Re: Medicare-D

"Howard Kaikow" <kaikow@standards . com > wrote in message
news:fp4du9$d4v$1@pyrite.mv . net ...
Where does the money come from in Medicare-D?

For example, suppose somebody gets a 3 month supply of various meds, and the
pharmacy claims that the retail price is, say, $180, but the premiums are
$20 per month,

Also assume that co-pays are $0.

So who pays the other $120(180-60)?

I'm thinking of a case in which the Explanation of Benefits states that the
pharmacy was re-imbursed the full $180 by the insurance company, i.e., the
medicare price was the same as the retail price..

What about Wal*Mart. They have a list of generic Rxs that they sell to
people without insurance for $4 cash. I had one that would have been $4 if
I had paid cash. I have insurance with zero co-pay for generics. But the
price listed for CMK Medicare was $34.46!

So do they get $30 more for filling it on Medicare as opposed to $4 if I had
them bill it as cash?
Or is it like most insurance payments? That is the insurance company gets a
big discount and pays only a percentage of the billed price?

Re: Medicare-D

The issues of concern are the following:

ASSuME $0 co-pays as it simplifies discussion.

Looking at the medicare.gov web site, the prices for drugs varies from plan
to plan, and from pharmacy to pharmacy.

Since few, if any, folkes over 65 take no prescriptions, one cannot expect
that the premiums from those not taking drugs are sufficient to cover the
costs for those taking prescriptions, so from do the funds come?

Not to mention, that higher retail/insurance prices push one closer to, or
into, the doughnut hole.

And what if the insurance company owns the pharmacy?
Can they 100% re-reimburse the phamrcy?

As with Mediare Adavantage, re-imburesments are limited by Medicare, are
there such limits for Medicare-D?