WellCare And Aetna Prescription Coverage

By Harry P. Thal
Special to the Sun

If it is on the Internet, it may not be true. This statement is very real when it comes to selecting a prescription drug plan or Medicare Advantage HMO if you reside in the Kern River Valley.

About a month ago, I received a personal (but form) letter from WellCare, my Medicare Part D prescription plan (2019) advising me that the Drugstore in Kernville would no longer be a “Preferred Pharmacy” but for 2020 would be a “Standard Pharmacy”.

For this current year, The Drugstore and Mesa Clinical Pharmacy, both Preferred Pharmacies, would cost me $16.58 to fill my seven medications of which four have a $0.00 co-pay. Rite-Aid, a Standard pharmacy in 2019 had a co-pay of $32.58 for the same medications.

For 2020, Mesa Clinical Pharmacy will join Rite-Aid and be classified as a “Standard Pharmacy” where my same list of medications will cost $40.96.
And here is where the Internet is wrong. It shows this rate for The Drugstore. However, Austin Horn has informed us that he will not be accepting WellCare plans nor Aetna plans in 2020, so if I keep my present policy, and wish to continue using The Drugstore in Kernville, my monthly cost would be $61.60. I can’t blame Austin, as this company is paying the pharmacies a minimal amount per prescription refill, as they are pushing their business to CVS and the supermarket chains as the primary “Preferred Pharmacies”.

Furthermore, the monthly premium was taking a small increase from $15 per month to $16.80. The plan’s deductible was also growing from $415 to $435.

While every person’s list of medication varies, so do the recommendations. This is why my office offers a free comparison service to our clients.
I am making a plan change. My new plan will cost me more per month, it will be $30.50 per month, but allows me to continue at the Drug Store (or Mesa Pharmacy) as they are “Preferred Pharmacies.” Three of my medications will be $0 and three will be a dollar. Only one will cost $17.80 and that one I really no longer need. Even keeping it, my monthly tab would be $20.80, and once dropped, it will cost me $3 to fill my medications. As a “Standard Pharmacy”, Rite-Aid has a $42.91 monthly cost vs. the $20.80.
The identical situation can be found if you have Aetna. All persons with an Aetna prescription drug plan in 2019 have been informed that Aetna has sold their prescription business to WellCare. This was part of a requirement for Aetna to be purchased by CVS.

I took my list of medications and looked up the 2019 Medicare Advantage Aetna Medicare Select Plan costs. Mesa Clinical Pharmacy in 2019 is a Preferred Pharmacy and all medications had a $0.00 copay but one (the one I really no longer need) which was $47.00. The Drugstore, a Standard Pharmacy would have cost me $140.33 per month and Rite-Aid, (also Standard) $145.01.

For 2020, the Aetna Select HMO has Mesa Clinical Pharmacy as “Standard” and my prescriptions will be $138.17 per month, $137.67 at Rite-Aid and about $171.23 per month at The Drug Store as they will be a non-participating out of network pharmacy.

The solution is simple. Change plans. There is more to selecting a plan than the cost of medications. The first criteria for most is your primary care and specialists covered on the plan. A plan available for patients of Doctors Montes, Lopez and Abrahamson will have a cost of $15.63 at all local pharmacies and a different plan available for patients of Dr. Finstad with prescription costs of $25.77 at all pharmacies.
Of course, pharmacy costs and doctor choice are only two of the components of plans. As we have most plans available in the county, other benefits are significant, and each plan recommendation is customized to the consumers needs.

As of Monday, The Drugstore is still listed as a participating standard pharmacy on the government’s Medicare.gov Plan Finder.

Harry P. Thal, MA, is a licensed insurance broker in California (0621106) and 27 other states. His offices are in Kernville. He may be reached at 760-376-2100, e-mail harrythal@aol.com or visit him on the web at www.harrythal.com.