Weird Medicare Part D Copay/Deductible

[Sparda29]

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I have a patient who gets these 5 medications:

Amlodipine 10 mg #90 - $0
Carvedilol 25 mg #180 - $0
Ramipril 10 mg #90 - $0
Simvastatin 20 mg #90 - $0
Digoxin 0.125 #90 $89.78

Why is digoxin the one drug that always seems to catch a copay/deductible while the rest are zero? And how the **** did digoxin get expensive? I thought it would be dirt cheap.

 

[Rouelle]

Maybe the part d plan is trying to increase it's star rating by not paying for something that doesn't "increase survival"?

 

[PharFromNormal]

Maybe the part d plan is trying to increase it's star rating by not paying for something that doesn't "increase survival"?

I think you're on to something with star ratings. If it's truly med D I'd leave it at that. From a pure incentive basis med D plans don't have skin in the game when it comes to survival. Maybe a MAPD plan cares a little more about survival but a pure drug plan sponsor cares about premiums, enrollment, star measures, maybe very little on survival if they can keep the patient on their plan longer.

 

[npage148]

Maybe beers list drugs are non preferred?

 

[zelman]

Maybe beers list drugs are non preferred?

This.

 

[Arjw2]

CMS considers digoxin a high risk medication for patients over the age of 65 so the physicians must attest to the medical necessity before it can even be processed through insurance. It's not "preferred" so that's why there's a copay

 

[MountainPharmD]

It depends on the insurance plan. Some Med-D plans have $0 co-pays for tier 1 generics. Some plans have a deductible. Humana has a $400 deductible that doesn't apply to tier 1 drugs. I'm assuming Med-D because of the drugs.