Express-Scripts

Questions and answers about medical benefits, severance pay outs. etc.

Express-Scripts

Postby jer on Thu Jun 06, 2019 6:09 pm

Hi all, trying to get some info regarding express-scripts for management retiree under the United Health Care PPO plans for future Medicare Advantage. Express scripts can't give me drug prices without a 'contract number' from UHC and UHC can't give me a contract number unless we actually sign up with them. This makes no sense, but hey, it's health insurance. I was wondering if anyone has the contract number for either the 250 or 400 Medicare Advantage plan for management employees or can give me an idea what the drug Lyrica costs with this plan. It's an expensive drug, but express could not give me any info as far as if how much, if it's covered, etc., without the contract number from UHC. Any help is appreciated- thanks!
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Re: Express-Scripts

Postby deathspiral on Fri Jun 07, 2019 7:44 am

I believe the numbers you are looking for can be found on the VzBenefitsXerox website that you might use to enroll. On that site, the UH Medicare Advantage PPO 400 Plan is listed as 112R and the Medicare Advantage Plan 250 is 111R.
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Re: Express-Scripts

Postby jer on Fri Jun 07, 2019 5:26 pm

Yes, I gave them those plan numbers but express scripts stated there is another 'contract number'. Without it they could not provide any definite info. I did get a 'guesstimate' based on what they had but could not tell me if those were the prices for a retired Verizon management employee.
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Re: Express-Scripts

Postby sarah_fGTE on Sat Jun 08, 2019 7:43 am

I have the Express Scripts Medicare Part D policy (not through VZ). For Lyrica, my plan considers it Tier 3 (preferred brand) and, after "medical review", I would be charged $354 for a 90-day supply of 100mg tablets taken 3 times a day (270 tablets total). If I used just one dose a day, it would be $118 for the 90 days. Don't rely too much on these figures, but it may give you a ballpark idea. I think it's crap that Benefits can't give you better information.
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Re: Express-Scripts

Postby deathspiral on Sat Jun 08, 2019 8:03 am

I did a quick search and for a 90 day supply of 100mg capsule, your cost would be $60. But, the medication is subject to a Coverage Review which I have never experienced.
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Re: Express-Scripts

Postby jer on Sat Jun 08, 2019 8:15 am

Thanks all for the info. I am expecting a medical review as that is what has taken place with our current insurance. Seems once medicare hits & you get a supplemental with a plan D or a Medicare Advantage plan they all want to do a 'medical review' to validate the medication given. The physician just signs off on it stating yes, it's needed and other/cheaper drugs have been tried with no success. Just another way of putting off getting what drugs you need I guess. On the bright side it looks like the UHC plan with ExpressScripts could be a better deal going forward. Gonna have to wait and see if the 'donut hole' for drugs really disappears for 2020 which MIGHT make some of these needed drugs cheaper. Of course, it could backfire and end up costing us all more-will have to wait and see.
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