I have been going through this for the last three years and each year I have to study the plans carefully to find the plan that will give me the best prescript
ion drug coverage.
I looked at the plan you mentioned BCBSM Medicare Advantage plan. Just to make sure is this a Blue Cross Medical Advantage Plan? If so, they do provide prescript
ion coverage and I found that Zytiga was on their formulary. The plan has three stages of prescript
ion coverage as follows: 1) Initial coverage stage;2)Coverage Gap, and; 3) Catastrophic Coverage. Each prescript
ion is categorized in tiers and Zytiga falls into tier 5 category. In the initial stage, you will pay 33% of the retail cost of Zytiga, up and until you reach a maximum of $3,750. You will then move into the coverage gap stage and will pay up to 44% percent of the cost, up to and including $5,000.00. This is your maximum out of pocket expense during the initial stage and coverage gap stage. Once you spend $5,000.00 you will move into catastrophic coverage and your monthly cost of Zytiga will be either an $8.35 copay or 5% of the cost, whichever is greater. It also looks like you have an additional PDP called Optum RX. I am not familiar with this plan so maybe you can shed some light on it. If it is additional coverage then your Medicare Advantage plan would pay first and then Optum RX would pay next. If this is the case then you may have additional savings.
I think that the PDP plans are complex and often time the representatives on the phone are no fully aware of how the drug plans work and it causes a lot of anxiety with me. But if it gets too expensive for me I am just going to let nature take its course and hope for the best. I hope this helps a little.
Post Edited (Almost a 10) : 10/22/2018 11:26:10 AM (GMT-6)