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Medicare Part d enrollment - frequent travelers be cautious


ghstudio
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Some workarounds I use as a frequent traveler on extended vacations prior to leaving:

 

1)  I tend to re-order any recurring prescriptions as soon as I can, and that eventually leads to an extra month or two extra supply.

 

2)  If my physician writes a new script for a new dosage, I build up an extra supply. {He has even replaced a daily 10 mg dose with a new order of 5 mg twice a day.}

 

It also depends where we travel.  I had a shoulder bag containing my meds  stolen in Barcelona.  I was amazed that I could get Eliquis and Bystolic without a doctor's order at any pharmacia.  Got 60 days of one and 90 days of the other for less than my co-pay back in the USA.

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With the renewal period beginning now, just a reminder to understand your Part B medical supplemental policy and whether it includes international coverage.  This is my first year retired, and oh do I miss my old corporate insurance. 

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Many Part D programs have arrangements with major drug stores (CVS for example) so they can fill 90 day prescriptions at the same price as mail order and in fact have discontinued their use altogether. I used to have to use mail-in programs for my wife and me for our 90 day prescriptions, but always worried that the Rx would get lost either going, or coming from the mail pharmacy. We were mailing Schedule II drugs (90 days legal at the time) and a lost prescription would have been a real problem having to get it rewritten. Even Costco will refill a 90 day prescription at less cost than the current mail order places. Just no reason for us to take a chance on mail-ins. 

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On 10/8/2019 at 6:25 PM, LoriPhil said:

This is my first year retired, and oh do I miss my old corporate insurance. 

With our supplement we haven't paid a dime out of pocket.  And our Chase Sapphire Reserve card has a very good trip insurance.

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On 10/8/2019 at 6:39 PM, evandbob said:

It also depends where we travel.  I had a shoulder bag containing my meds  stolen in Barcelona.  I was amazed that I could get Eliquis and Bystolic without a doctor's order at any pharmacia.  Got 60 days of one and 90 days of the other for less than my co-pay back in the USA.

 

Another thing to do, would be when in Europe, pick up a month or so of your meds over the counter.  Then put them in your rotation.  That way, you will always have an extra month or two.

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On 10/8/2019 at 10:39 AM, Jim_Iain said:

Thanks for the warning.    I ran into this but just contacted my Doctor and he wrote a new prescription with a 90 day  supply.  May not work on all drugs but a quick way to work around limitations.  I have Kaiser Senior Advantage and they will fill 90 day supplies either by mail order (usually 1-2 days) or picking up at one of their pharmacies. 

 

We have Kaiser Senior Advantage too. The 90-day mail order supply that they send for pills that I take once per day is 100 pills (I guess to allow you to be imperfect and sometimes drop a pill on the floor and discard it). Plus they allow refill a bit earlier than 90 days so it's never been a problem to have enough extra for a trip.

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I was just checking, as now BC will only provide 90 days per year of Ambien.  And I use it due to frequent international travel.  

 

So I was pricing it through GoodRX.  And one local pharmacy $62 for a refill.  Another is $8.96.  Another prescription would be $265 at one pharmacy, at another $21.36.

 

So it may be possible to use GoodRX or similar, and just buy a month of two of your meds.

 

Might not work for all of them, but might help out some.  Of course, your doctor would need to provide additional prescriptions.

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Just curious, are you pricing brand or generic? I used to take 12.5 mg CR of Ambien and then the generic when it became available every night for a few years before it gave out. The doctor then switched me to very low dose (10 mg) of amitriptyline, which works better and is dirt cheap.

 

Good luck with your pricing wars, it is a jungle out there! 

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The original poster mentioned thyroid med  specifically. I have found there is a great deal of variance in effectiveness from one generic brand to another (I've been told it has something to do with fillers and manufacturing processes). I can get a months supply from my local Walgreens that works fine, but the 90 day mail-order left me feeling terrible. So sometimes sticking to a pharmacy with a generic that works is an issue.

I have had my physician write for 50mcg twice a day (though I continue to take it once daily) instead of my normal 100mcg. So I got the med I needed when I couldn't get another emergency override.

I have also used GoodRx for another drug - in fact I now use Good Rx instead of my insurance for some meds. I always check with them before I get a new prescription filled, and go with whichever is cheaper.

Seems to me the 90 day supply thing may be prevalent for all Medicare part D. Work-arounds are possible.

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On 10/14/2019 at 6:32 PM, sptrout said:

Just curious, are you pricing brand or generic? I used to take 12.5 mg CR of Ambien and then the generic when it became available every night for a few years before it gave out. The doctor then switched me to very low dose (10 mg) of amitriptyline, which works better and is dirt cheap.

 

Good luck with your pricing wars, it is a jungle out there! 

 

Generic, non-CR.  I actually use a combo of non-CR and CR (and for some of you, YES, this has been discussed with and approved by my doctor).  The CR is a good bit more expensive.  It is around $50 for 90 tablets.  This is also for generic.

 

I still get my CR (actually ER in generic) through my regular pharmacy, charged to my insurance.  And the copay is a lot less then buying it through GoodRX.

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On 10/15/2019 at 12:16 PM, herbanrenewal said:

The original poster mentioned thyroid med  specifically. I have found there is a great deal of variance in effectiveness from one generic brand to another (I've been told it has something to do with fillers and manufacturing processes). I can get a months supply from my local Walgreens that works fine, but the 90 day mail-order left me feeling terrible. So sometimes sticking to a pharmacy with a generic that works is an issue.

 

The problem is, the generic can change from refill to refill.

 

My last refill for thyroid med, was partly filled with one generic (round pills) and partly filled with a different generic (little logs).

 

I have a fried that has to take non-generic thyroid.  I am fine with any of the generics I have taken.

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6 minutes ago, SRF said:

 

Generic, non-CR.  I actually use a combo of non-CR and CR (and for some of you, YES, this has been discussed with and approved by my doctor).  The CR is a good bit more expensive.  It is around $50 for 90 tablets.  This is also for generic.

 

I still get my CR (actually ER in generic) through my regular pharmacy, charged to my insurance.  And the copay is a lot less then buying it through GoodRX.

 

I had good luck with the ER for months before it gave out like I mentioned earlier. After I stopped ambien I happened to look a little deeper into the actual difference between the the instant release (IR) and the ER version. Not that much difference over 8 hours. I agree that mixing the IR & ER versions is not an issue, especially since the difference is minor.

 

Have you tried Costcos if you have one nearby? I was off of ambien before I started buying prescriptions from them, but I would bet that you would save at least 50% off that $50 price. They usually beat the crap out of all competitors when selling generics.

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2 hours ago, sptrout said:

 

I had good luck with the ER for months before it gave out like I mentioned earlier. After I stopped ambien I happened to look a little deeper into the actual difference between the the instant release (IR) and the ER version. Not that much difference over 8 hours. I agree that mixing the IR & ER versions is not an issue, especially since the difference is minor.

 

Have you tried Costcos if you have one nearby? I was off of ambien before I started buying prescriptions from them, but I would bet that you would save at least 50% off that $50 price. They usually beat the crap out of all competitors when selling generics.

 

I travel internationally a lot.  So I use it to help get over the time displacement.

 

With standard Ambien, I found it would get me to sleep, but I could wake up 2 - 3 hours later, and not be able to get back to sleep.

 

With the CR/ER, it can take a longer time for me to fall asleep.

 

The combo, I fall asleep quickly, and sleep at least 7 hours.  Plus, I can get up for a bathroom call, and fall back to sleep.

 

There may not be a big difference technically, but for ME, there is a significant difference in performance.

 

The best price for me, through GoodRX, was at Costco.  Safeway was also pretty cheap.  That $50 for the CR/ER WAS at one of those two, and the other was a few cents different.  The non-CR/ER is much cheaper.

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Interesting that you can take both IR & ER ambien at the same time. Never thought of that combo. I did not travel internationally before I retired and rarely do now (two time zones usually max). In any case, I cannot use ambien anymore. I am glad that you found a method that works for you and a doctor, and pharmacist, that will work with you prescribing/taking both. Here in Houston I do not think that I could fill both without a battle. All the major drug stores here got together and, as a group, decided not to fill any scheduled medication more than three days before a refill is due (my pharmacists told me this). Not related to your situation, but does show that there are different rules depending on where a person lives. If the FDA doesn't mess things up enough then the local pharmacies jump in. It is a real problem for anyone taking a scheduled medication(s). 

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I had trouble with Blue Cross with the two.  For a while, they would not do both, because they were "the same thing."  Then one year, it was fine.  For a few years.  Then not.  Then the new rule of no more than 90 per year.

 

The doctors and pharmacists have all been fine with it.

 

I have been 7, 9, and 12 times zones away in the last 6 months. 😄

 

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2 minutes ago, SRF said:

 

I have been 7, 9, and 12 times zones away in the last 6 months. 😄

 

 I would be a zombie for at least a week. I cannot handle time changes very well at all. Even our upcoming switch to Standard Time will mess me up for at least a week.

 

My next door neighbor travels all over the world and he says that jet lag is not a problem for him. Most of his trips are less than a week regardless how far he travels.

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5 hours ago, sptrout said:

 I would be a zombie for at least a week. I cannot handle time changes very well at all. Even our upcoming switch to Standard Time will mess me up for at least a week.

 

My next door neighbor travels all over the world and he says that jet lag is not a problem for him. Most of his trips are less than a week regardless how far he travels.

 

If you do it a lot, you get used to it.  And it becomes easier.  And using a sleep aid, to SLEEP during normal sleeping hours for where you are, helps a LOT.

 

But there are even some little things.  I reset my watch to the destination time, as soon as I am on board the flight.  So, for a flight to Europe, instead of looking at my watch and saying, hey, it's only 6PM.  I look and say, HEY, it's midnight, I need to take a nap. 😄

 

 

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We have been fortunate that our drug store knows and will provide as many pills as we need for our cruises.  Some of the cruises have been 28 days with several days before and after the cruise in hotels.  And there was a time when we took 4 and 5 cruises a year.  They even prepped the bottles for us.

 

Nice to have people take care of us as we get older.

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The problem is seldom the pharmacy.

 

It is the insurance that sets the limits.

 

This is why I posted about GoodRX, so you may be able to just outright buy a few months supply to have a flex for travel.

 

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2 minutes ago, SRF said:

The problem is seldom the pharmacy.

 

It is the insurance that sets the limits.

 

This is why I posted about GoodRX, so you may be able to just outright buy a few months supply to have a flex for travel.

 

 

Many drugs are "Scheduled" (I have no idea how many, but nearly all of ours are; I think they all are), and if so, the government controls how many pills can be dispensed in a given a time period. The drugstores use a government database that shows what a person has been prescribed at all drugstores. In our case, I have not been able to find anyway around the strict limits for Scheduled drugs here in Houston. I expect that some kind of exception to the rules are allowed if you can prove that you will be out of the county when a refill is due, but so far we have not had this situation come up.

 

GoodRx is no help at all in getting around the rules; the same rules apply to them as any other type of Plan. We seldom use it anymore since Costco's plan always beat even their own GoodRx price. Before joining Costco, we did use GoodRx or at least check it to get the best price for a given drug. Now that is even getting difficult since most doctors want to electronically send a new Rx directly to a drugstore that I specify on the spot. No chance to price compare. If asked quickly enough they may agree to write an Rx, but that is not the preferred method. My guess is that paper prescriptions will soon be a thing of the past.

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Then you need a new doc.  Mine have always been fine with writing a paper script.  One, it was even automated, so she had to just sign the slips.  Current one has to hand write them, but does so when asked.

 

Yes, scheduled drugs are an issue.  

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