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Thread: Wanna rant about Medicare/Medicare PPO???

  1. #1
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    Wanna rant about Medicare/Medicare PPO???

    WARNING!!!!
    Major Rant ahead......

    I have been on Cymbalta 60mg and Ultam ER 100mg off and on since June. In September, I went off the Ultram because it was too expensive and I was already in the "donut hole". I went back on the Ultram ER in December only to find out the end of December that a severe reaction called "serotonin syndrome" can occur when combining the two. I called my doc and she put me back on Darvocet N-100 for my pain. I cant take any Ibuprofen containing products or NSaids due to stomach ulcers from the same a couple of years ago.

    I get a letter from Humana today stating that my refill was a temporary as my doctor needs to provide authorization as to why I need this medication. There is a limit as to what they will dispense and 60 per month or 2 a day is too much.

    If I get this filled at walmart without using my insurance the cost is around $20.00. If I get it through Humana, it will cost me $4.00 plus take away $30.00 from my $2250.00 which will put me in the donut hole. I spent $3900.00 roughly on my medicines last year. I have been on the same drugs for most of the year. It is far cheaper for me to take the generic darvocet as opposed to the Ultram ER which worked great minus the side effect risk.

    To add insult to injury, I went to the Medicare drug website to check other drug providers. It seems if I put all my drugs in the site, the yearly estimated cost is $412.00 for my current 4 (Enablex, Questran, Cymbalta, and Generic Darvocet N-100) drugs on the plan that I am already on (Humana gold choice).

    Something is really wrong here as I paid $3900.00 last year for 55 prescriptions. The four I am on regularly and UTI episodes. Since the first day of October, I have been in the donut hole to the tune of $400.00 a month.

    The Medicare drug program is a rip off!!! I think it is just a numbers game.... Anyone else got bad experiences???
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

  2. #2
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    I am so glad to hear of this, last year I fell into the "hole" at the very end of the year, i thought i was getting the best coverage, apparently not, I am now in a different plan, I fear they will execute a hole sometime this year, I have started to get scrips done at Sam's club, and am not sure if it is any better than Eckerds, they say they are. I know I will find out, when , wher, not sure, but I willl get a rude awakning soon, I fear, I knew it sounded too cheap, and I think I will have to switch when I can, to what, I don't know. Keep this thread going, it may not cure, but it willl save$$$$$$$$$$ Maybe a cure is cheaper, and will come sooner? Who knows, inquiring minds need to know!!!!

  3. #3
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    I will find out in February.

  4. #4
    I got the Humana cheapie plan for $18 a month with the $250 annual deductible. I'm only on 2000mgs of gabapentin ($60 a month) and 20mgs of diazepam (not covered!) a day. Well the new year just started so the great Medicare prescription drug program (Part D) won't pay a thing for the next 5 months until my deductible is met yet I'm paying $18 a month for the "privilege". So in June they'll start paying 70 or 75% of the gabapentin. So Part D actually costs me money every year unless I get really sick and need some other medications.

    And this really gets ridiculous after they start covering the 70 or 75% of the gabapentin. They send me an 8 page letter every month, I guess to remind me of what a great service they're rendering me. It even includes a color picture of the 400mg generic Neurontin (gabapentin) capsule. What a freakin' waste of ink and paper!

    Hopefully the Democrats will "fix" some of this bullshit.... there should be Congressional hearings on it this or next week airing on C-SPAN 1, 2 or 3 depending on whether the House or Senate is in session or not. When I find out when and where the hearings are being held I'll give ya heads up. This should be fun to watch!

    As fun as that stupid "donut hole" is. Plus the 400 billion dollar, 10 year long Part D program that will actually cost the government over a trillion dollars. What a windfall for the Pharmaceutical Corporations. It had to be sold to the legislators at or under the 400 billion dollar over the 10 year mark or it wouldn't have passed even after the 15 minute vote was "held open" for 3 hours so some "cloakroom" arm-twisting could be done at 2 or 3 in the morning! Creative accounting. I still remember watching it.... insomnia.

    Hmmm, I wonder what the healthcare and prescription drug plans are like for the legislators, judiciary and the president and their families.... the "People's Servants". I wonder (actually I don't!) if they have a "donut hole" in their healthcare policies.

    It was a "gift" from the Republican controlled Congress to Bush.... so he could look like the "compassionate-conservative" president that he promised to be while campaigning for the presidency.

    The new Democrat majority Congress will try to repeal the portion of the Part D program that prohibits the HHS from negotiating for lower drug costs. Just like the V.A., Canada, Mexico and Europe etc. do. Maybe they'll repeal the ban on the "re-importation" of drugs from Canada and close the "donut hole" too. We can hope.

    We can also hope to put some sanity into this gift to the Pharmaceutical Corporation's monopoly and the extensive K Street lobbying. Prior to and during the passage of the Part D program there were TWO pharmaceutical lobbyists for every one Congressperson... they must have been tripping over themselves in the halls of the "People's House". What a sick joke.
    "Be kind, for everyone you meet is fighting a great battle." - Philo of Alexandria

  5. #5
    That sucks BIG TIME.
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  6. #6
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    Now That"s One Helluvarant!!!!!!!!!!!!!:

  7. #7
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    Well I just logged into Humana and got my detailed description. For my 55 prescriptions....

    Cost- 3907.19
    Humana Paid- 1174.61
    I Paid out of my pocket- 2732.58

    Now they want authorization for my measly prescription of Darvocet. After 18 freakin years of gritting my teeth with pain.....my hips are worn out because Medicare wouldnt pay for me to have new braces. I have been in the same brace for 18 years so now I have to beg for a little relief.

    I am going to fill my prescription at walmar and not even bill the insurance...I will pay the $30.00 dollars a month. By the way, 60 pills through my humana plan costs 29.97. At walmart, I can get 90 pills for 31 and some change. If I get them at walmart, they cant tell me how many I can take a month.

    I told you it was a number game.

    In 2006, the refill for generic Darvocet on december 3 cost me $8.81. I was in the donut hole then so I paid the full cost of $8.81. I refilled the same prescription on Tuesday of last week at the same pharmacy and I paid $4.00 as that is the copayment for generic drugs on my plan now. It cost me $29.97 out of my yearly total towards the donut hole. It makes no sense. Why not $8.81 as that is what it cost me a month ago....generic now not brand????

    Does that convince anyone else it is a numbers game???
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

  8. #8
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    This is interesting from the orlando sentinal about drug costs...

    http://blogs.orlandosentinel.com/fea..._medicare.html
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

  9. #9
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    If they cant negotiate prices....how does that help with the cost of drugs?

    http://www.wzzm13.com/news/news_arti...?storyid=68231

    What a joke?
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

  10. #10
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    Quote Originally Posted by alhavel
    I am so glad to hear of this, last year I fell into the "hole" at the very end of the year, i thought i was getting the best coverage, apparently not, I am now in a different plan, I fear they will execute a hole sometime this year, I have started to get scrips done at Sam's club, and am not sure if it is any better than Eckerds, they say they are. I know I will find out, when , wher, not sure, but I willl get a rude awakning soon, I fear, I knew it sounded too cheap, and I think I will have to switch when I can, to what, I don't know. Keep this thread going, it may not cure, but it willl save$$$$$$$$$$ Maybe a cure is cheaper, and will come sooner? Who knows, inquiring minds need to know!!!!
    According to the website I am on the best paying plan for my drugs for my area.....
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

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