Drug "Not on Formulary"
When you do a drug plan search on the medicare.gov website, sometimes the insurer may state that your drug is "not on the formulary". In such a case, you will pay "retail" price and the payment will not count toward your $2250 total retail drug costs--that is, it will not help you reach the gap or get through the gap. One individual that I helped was paying cash for his drugs and was using two drugs that were "not on the formulary" of any carrier. The so-called "retail" price that the carrier was charging for this drug was almost $12.00. The individual who had been paying cash had been paying almost $100 for the drug. We took the printout from the website to the pharmacist and he said, in effect, there are two "retail" prices: one is for cash paying customers, which can be up to ten times the "retail" price that the pharmaceutical company charges the pharmacy. Just by joining a plan, this individual will save $85 a month even if the drug is not on the carrier's formulary. Figure that!!!!