Q1Medicare.com Now Provides Comprehensive Medicare Part D Drug Pricing Information

Share Article

Q1Medicare.com has updated their Medicare Part D online drug tools to include the average negotiated retail prescription drug prices, along with a prescription drug plan cost-sharing matrix, estimated drug cost matrix, and prescription drug pricing history. The updated Formulary Browser and Drug Finder tools provide access to this detailed cost-sharing and pricing information for each Medicare Part D prescription drug plan or Medicare Advantage plan formulary drug. The Q1Medicare Formulary Browser and Drug Finder tools are available to all site users at no cost and are designed for computer, smartphone, and tablet platforms.

Along with the basic retail price information, we decided to go one step further with our Medicare Part D estimated drug cost matrix and provide the Medicare community with an explanation of how the estimated drug cost is calculated.

Q1Medicare.com has released their updated Medicare Part D online drug tools that now include the average negotiated retail prescription drug prices, along with a plan cost-sharing matrix, estimated drug cost matrix, and prescription drug pricing history. The updated Formulary Browser and Drug Finder tools provide access to this detailed cost-sharing and pricing information for each Medicare Part D prescription drug plan or Medicare Advantage plan formulary drug.

The drug cost-sharing and estimated drug cost information includes five different sections of pricing detail that is provided on a Medicare plan and drug level. To view the estimated cost and cost-sharing details, the Q1Medicare.com user only needs to click on either the 30-day or 90-day supply cost-sharing figure in either the Formulary Browser or Drug Finder tools. The Formulary Browser can be found directly at Q1Medicare.com/FormularyBrowser and the Drug Finder at Q1Medicare.com/DrugFinder.

The first section of the pricing detail includes the Medicare prescription drug plan’s average negotiated retail drug price for the plan’s service area. The retail drug price provides the beneficiary with information that is used to calculate co-insurance and to determine when the beneficiary will go into, and get out of, the coverage gap or Donut Hole.

The second pricing section includes the Medicare Part D plan’s cost-sharing matrix. This section details the plan’s cost-sharing for a 30-day and 90-day prescription supply at preferred network pharmacies, network pharmacies, and mail order pharmacies across all plan coverage phases. This section shows the plan’s actual co-payment or co-insurance percentage for each phase of coverage and reflects the cost-sharing information found in the Medicare Part D plan’s Summary of Benefits document.

To help people estimated what they can expect to pay at their pharmacy during the different coverage phases, the third section provides an estimated drug cost matrix. This matrix includes the estimated amount the beneficiary can expect to pay for a 30-day and 90-day supply at a preferred network pharmacy, network pharmacy, and mail order pharmacy. The estimated drug cost reflects purchases made in each phase of Medicare Part D coverage including the initial deductible, initial coverage, coverage gap or Donut Hole, and catastrophic coverage phases. The estimated cost is calculated to include more complicated “straddle claim” logic, “lesser of” logic and coverage gap or Donut Hole discounts.

The fourth pricing section combines the information from the second and third sections producing a matrix of cost-sharing with the estimated drug cost followed by an explanation of the estimated drug cost calculation for a 30-day supply purchased at a preferred network pharmacy with a detailed explanation including information on the coverage gap or Donut Hole discount, straddle claims, and claims using the “lesser of” logic.

The fifth section lists the pricing history for the average negotiated retail price of the specific drug for the selected Medicare prescription drug plan or Medicare Advantage plan.

“Along with the basic retail price information, we decided to go one step further with our Medicare Part D estimated drug cost matrix and provide the Medicare community with an explanation of how the estimated drug cost is calculated,” notes Dr. Susan Johnson, Technical Director and co-founder of Q1Group LLC. “Many of the cost-sharing calculations are simple, especially for co-payments, but when dealing with the more expensive medications and straddle claims comes into play, many people find it difficult to understand how the pharmacy calculated their point-of-sale cost.”

The Q1Medicare Formulary Browser and Drug Finder are available at no cost and designed for computer, smartphone and tablet platforms. The results of the Formulary Browser, Drug Finder and Retail Drug Pricing are also formatted to be printed for offline use or sent to an eMail account.

About the Q1Medicare.com Website
Q1Medicare.com is one of the largest independent online resources for Medicare Part D prescription drug plan and Medicare Advantage plan information. Q1Medicare offers a large selection of Frequently Asked Questions, online tools, and a free Medicare Part D Newsletter all designed to help Medicare beneficiaries, healthcare professionals, advocates, advisers, caregivers, and insurance agents better understand both the Medicare Part D prescription drug and Medicare Advantage programs. Q1Medicare.com is operated by Q1Group LLC (Saint Augustine, Florida).

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Lynnea Christner

Susan Johnson MS-MIS, MBA, PhD
Follow us on
Visit website