Prescriptions/Medicare/Coupons

[hcoles]

FYI - for those that have Part D coverage and are also covered by Medicare. I have Medicare, AARP Plan F (part B coverage) and Silverscript (part D coverage). This is a short story of an experience I had as part of learning about Medicare and prescriptions/etc. Hopefully some here with more knowledgeable can chime in and help clarify how the "system" works.

I had watery eyes and my optometrist said I had low producing oil glands in my eyelids. So I visited an ophthalmologist and he said it looked like I had an allergy and prescribed Pazeo. Pazeo are/is eye drops. The eye doctor gave me a coupon where I might pay as little as $10. The doctor also gave me a sample of Pazeo which seems to help.

I checked with Blinkhealth to see what the cost and discount would be if I paid cash. Cash $177 and with Blink $172, so not much help there. I think this works out to more than $1 per drop. I checked with CVS and on my Silverscript plan my cost would be $47 copay (currently Pazeo is tier 3). I wanted to see if I could make the $10 coupon work.

I called McKesson to see how to use the discount coupon and the guy said I can go in as if I was a cash customer and the coupon should work. It didn't. It turned out that since I have Part D coverage connected with Medicare the coupon can't be used. And I'm not able to just pretend to be a customer without coverage. Somehow the "system" at CVS, probably connected with Medicare, figured that out. It's not clear who is eligible for the coupon, it says "Valid only for those with commercial insurance". What does that mean?

I called Silverscript and asked for a change of "tier" from 3 to 2. If I can get the tier changed I can get the Pazeo for a $17 copay. They will let me know in writing after 72 hours if my application of a tier change was approved.

I'm attempting to learn how all this works, possibly some of you are in the same boat.
The bottom line is some of these coupons may not be as easy to use as they initially appear. The various pricing models related to prescriptions seem to be rather complex.

[Tobra]

The coupons usually do not work with federally funded healthcare insurance, hence Medicare, Medicaid, Tricare or anything else paid for with federal dough you can't use them. Everything else is commercial insurance, like what you get through your employer, not sure how it works with exchange healthcare insurance plans.

If you get them to change the tier on that medication, you should probably go ahead and buy a bunch of lottery tickets while your miracle working powers remain in effect.