I get my medicine through Skip's pharmacy. When I submit a claim to my Medicare advantage plan, they tell me that I need to find a compounding pharmacy that is in my area. I've talked to 2 different people and just get the runaround. I will try again, but was wondering if anyone else has had similar problems.
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I'm currently on Ampyra and heard I won't be eligible for the mfg co-pay I currently receive when I move to Medicare later this year - so I guess I'll be going to 4-AP.
I remember others saying they use Skip's so interested in any info provided re: claims. -
Advantage plans are HMO's, and HMO's have closed networks. As a condition of enrollment, enrollees have to get all of their care -- including pharmacy -- only from network providers. That condition is explained in enrollment materials. Even if you don't remember, you agreed to use only network providers when you enrolled. Apparently, Skip's is out of network for your Advantage plan, so the plan doesn't have to cover any prescription you fill there. You're actually fortunate that they're going to allow you to find your own compounding pharmacy within their location rules. A lot of Advantage plans wouldn't. Don't be surprised if the person who told you that you can find your own pharmacy was wrong and coverage is denied later. Out of state is always out of network, except in an emergency.Comment
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I made the move to 4-AP when I transitioned to Medicare. My plan is original, not Advantage. Ampyra would have run close to $4000 a year since my prescription would no longer be subsidized by the company. I am very happy with my decision and have found I like 4-AP better than Ampyra. I use Skips, and it costs me $47.00 a month including postage for 120 tabs. They are a great pharmacy to work with. I take 1, 5mg. tablet every 3-4 hours.Comment
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