Current Retiree (Medicare eligible) pharmacy situation
Baltimore City Retiree PharmacyDiscussion AgendaFebruary 9, 2017Current Retiree (Medicare eligible) pharmacy situationPlan DesignRetail - $5 generic/$30 brand formulary/$50 brand non-formularyMail Order - $12.50/$75/$125Monthly Cost – each pension checkSingle $652 party $131Recent legislationMedicare Modernization Act of 2003Establish Part D for outpatient drugs. Private plans provide this voluntary benefitEstablished the coverage Gap or “donut hole”Affordable Care Act of 2010Gradually closes the coverage gap 25% coinsurance for Retirees on brand drugs in the coverage gap in 2020Baltimore City Retirees in 2020Current retiree Rx plan ends 12/31/2019Saves Baltimore City an estimated $50.4 FY 2016-FY 2020Reduces the City’s GASB obligationRetirees will buy Pharmacy coverage in Medicare Marketplace10/15 to 12/7 open enrollment by CMSPrivate plans highly regulated by CMSLow income subsidy (est. as under $20k) Part D Medicare MarketplaceWide variance of plans to selectWide variance in Cost$35 per month 2017 average cost for standard plan per CMSDifficult to predict the monthly cost for 2020Premium Surcharge (35-80%) for retirees with over $80k in individual annual income Impact on Baltimore City Retirees in 2020Some retirees will be negatively impacted by this change based on your drug usageCoinsurance on Brands, not copaysCMS formulary versus currentPremium cost are rising about 8% a yearGreater unpredictability in out of pocket costsShopping for a pharmacy plan will challenge some retireesOften 5 drug tiersFuture of Medicare Part D is fluid and hard to predictACA repeal?Loss of big pharma subsidy on brand drugs for the coverage gapTrumpcare?Effective and frequent communication from Balt City is requiredRetirees must start learning about Part D this fallUse preferred drugs and preferred pharmaciesWork with your doctorMonitor the Part D marketplace ................
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