There is a lot of buzz surrounding the Part D plan from Humana. The most significant feature is the plan’s premium, touted as one of the lowest Part D premium for 2013. At $18.50 per month, the Humana Walmart-Preferred RX Plan looks pretty enticing, but is it for everyone?
Members of the Humana Walmart RX plan are required to pay a $325 annual deductible for all tiers.
Below are co-pays at preferred pharmacies. Preferred pharmacies include; Walmart, Sam’s Club and Neighborhood Market Pharmacies.
- Tier 1 Preferred Generics $1 co-pay.
- Tier 2 Generics $3, $4 or $5 co-pay.
- Tier 3 Non Preferred Generics and Preferred Brand 20% coinsurance.
- Tier 4 Non Preferred Brand 35% coinsurance.
Copayments and coinsurance using the RightSourceRx mail order plan.
- Tier 1 $0 co-pay.
- Tier 2 $0 co-pay.
- Tier 3 20% coinsurance.
- Tier 4 30% – 35% coinsurance.
- Tier 5 Specialty 25% coinsurance.
Staying within the preferred pharmacy network will give you reasonable copayments. This is not the case with non-preferred pharmacies. So if you use popular pharmacies such as Walgreens, CVS, Safeway, Rite Aid, Kroger…… the list goes on, you will pay much higher copayments.
At non preferred pharmacies you will pay:
- Tier 1 $6 to $10 copay.
- Tier 2 $8 to $33 copay.
- Tier 3 25% coinsurance.
- Tier 4 31% to 50% coinsurance.
- Tier 5 Specialty 25% coinsurance.
Analyzing the data
There are many Part D plans that do not require an annual deductible. So aside from co-pays and any expenditure in the donut hole, the monthly cost is very straight forward. It’s the monthly premium.
With a 2013 Part D insurance plan that requires an annual deductible, we need to do a little math. This will not apply to those who do not require any medications, but have Part D just in case or to avoid a Part D late enrollment penalty down the road. But if you are taking any amount of medications, it’s fairly safe to say that they will cost at least $325 over the course of the year.
The annual deductible needs to be amortized over 12 months. That would equal $27.08 per month. Added to the monthly premium of $18.50, you now have a monthly cost of $45.58.
The most likely real monthly cost of this Humana Walmart Part D plan is in line with the average price of Part D nationally. Certainly, plans with expanded formularies, including Humana Complete PDP will be considerably more.
As a point of comparison, AARP MedicareRX Preferred falls into the average price range and you do not lose the freedom to choose from a much larger network of pharmacies. This should be taken into consideration.
The bottom line
If you do not require any medications or only an occasional medication for a short time, the low price is a big benefit. Having this plan and making it through the year without any required medications will keep an average of $300 in your pocket. Now the question…. what percentage of people on Medicare require no medications?
We have not addressed the formulary for the Humana Walmart-Preferred RX Plan because everyone’s needs vary. But the formulary is even more important than monthly premium and copay amounts. If your drugs are not on the list, who cares what it costs?
Assuming your medications are included in the formulary, the biggest benefit may be the copayments for Tier 1 and Tier 2 drugs using the RightSourceRX mail order plan. After all a Tier 2 drug is often in the $40+ range with many other Part D plans.
The bottom line? This plan could be a big benefit for certain groups of people, but for others, maybe not. You will need to get your hands on the formulary, decide if you can stay with preferred pharmacies or use the mail order option and look at your individual situation. Whether or not the plan is for everyone or not, is not critical. The good thing about the Humana Walmart-Preferred RX Plan is it offers more choice and fits the bill for certain individuals.