FAQs
While every healthcare professional faces a unique set of circumstances, there are many common inquiries about prescriptions and medications. This list of frequently asked questions is a great place to start. You can also download a chart to see how The Experea Pharmacy Card works and view our Settlement Brochure
Q: What’s the main benefit of using The Experea Pharmacy Card?
A: Because this program was designed for those with specialized funding situations, the pricing is set to match the requirements of managing a variety of fund types. This program simplifies your job by automatically providing pricing that complies with the specific fund type and access to prescription purchase reporting to help you track and report expenditures.
Q: How much will my client save on prescriptions when using The Experea Pharmacy Card?
A: Even with our pre-negotiated discounts, the actual savings on each prescription may vary. Typically, members can save an average of 20% off the pharmacy’s retail prices for generic prescription drugs. And, they may save even more by ordering prescriptions through the mail, with the added convenience of delivery right to their door.
Q: Will my client always receive the lowest price?
A: Yes, they will receive the best price available with The Experea Pharmacy Card
at the pharmacy. On occasion, pharmacies will price a particular medication lower than the discount rate provided by the card. If that occurs, your client will receive the lower price.
Q: Will I be able to find out the discounted price of my clients’ prescriptions before going to the pharmacy?
A: Prices are based on pre-negotiated discounts but they vary by location. Only the actual pharmacy can tell you the exact price of the prescription.
Q: Why do the prices of prescriptions sometimes change from previous purchases?
A: Drug prices are different from pharmacy to pharmacy. Even chains have different prices in their stores depending on the customers they serve. Additionally, manufacturers’ drug prices change periodically.
Q: The brochure says my clients can save an average of 20% to 40% on prescription medication. Will they save 20% on all their medications?
A: Even with our pre-negotiated discounts, the actual savings on each prescription may vary. Typically, members can save an average of 20% or more. While manufacturer prices change periodically and each pharmacy has a different pricing policy, members can be confident they’ll get the lowest available price for prescriptions.
Q: Can my client get an additional discount off the Wal-Mart Generic Drug Program – $4 for select generics – if they show The Experea Pharmacy Card?
A: No, when presenting The Experea Pharmacy Card, members will receive either the pharmacy’s regular price for the prescription medicine or the discounted price, whichever is lower. If Wal-Mart’s $4 price for select generics is lower than the Experea price, they will pay $4. They will receive the best price available for that prescription medicine on that day from that pharmacy.
QUESTIONS ABOUT MEDICARE SET-ASIDE
Q: Who is the allocation company?
A: The allocation company is the reporting company used for the medical portion of the settlement, hired to identify the medical cost for future medical needs. This includes things such as physician visits, medication, and surgical procedures.
Q: How does the allocation company’s reports to Medicare affect the settlement?
A: The Centers for Medicare & Medicaid Services (CMS) require that the pricing used for medications is based on a RedBook Average Wholesale Price (AWP). Medicare determines if the pricing submitted is the Average Wholesale Price (AWP), adjusts it as needed, and sends a determination letter to the allocation company showing the outcome. Medicare may agree with what is submitted or raise the price. This process assures the treatment costs are fair and prevents shifting of burden to Medicare.
Q: What type of discount will my client receive when using The Experea Pharmacy Card at a participating pharmacy?
A: After the case settles, the claimant is usually stuck paying walk-in pricing or “retail” at most pharmacies, which is typically 20% to 40% higher. If your client’s medical money is based on RedBook and they are buying at retail rates, their money won’t last as long as projected.The Experea Pharmacy Card pricing is set at RedBook Average Wholesale Price (AWP) or less so members are never overcharged.
Q: What happens after the case settles?
A: When your client receives a settlement check for medicals s/he is typically instructed by the attorney to deposit the settlement check into an interest-bearing Medicare Set-Aside (MSA) account to use only for medical payments related to the injury that would normally otherwise be covered by Medicare. Whether professionally or self-administered, the administrator is required to keep records of payments made from the account.
Q: Are there situations when my client should not use The Experea Pharmacy Card?
A: To make sure a prescription qualifies for payment from a Medicare Set-Aside (MSA) account, a member should first answer two questions:
- Is this item related to my injury? Anything related will be identified by a physician.
- Is this item normally covered by Medicare? Medicare Set-Aside (MSA) accounts cannot be used for anything that Medicare does not “normally” cover.
If a member can answer “yes” to both questions, then s/he may use The Experea Pharmacy Card. If a member cannot answer “yes” to both questions, s/he must use another method to pay for that prescription. If the physician is unable to verify whether or not a prescribed treatment is covered by Medicare, your client may always call 1-800-MEDICARE to confirm.
Q: For what medications will The Experea Pharmacy Card work?
A: When the Medicare Set-Aside (MSA) plan type is selected during the registration process, The Experea Pharmacy Card will only process medications normally covered by Medicare. It will not process non-Medicare items. This protects members from spending the money improperly.
Q: Why is following Medicare’s guidelines for managing the Medicare Set-Aside (MSA) account spending so important?
A: If the money is not spent correctly then your client will not be able to use his/her Medicare insurance for injury-related treatment should the Medicare Set-Aside (MSA) fund become depleted. Doing so properly is crucial to protecting future Medicare eligibility for injury-related treatment.
Q: Why is reporting MSA account expenditures to Medicare so important?
A: At the end of every year, and/or when a Medicare Set-Aside (MSA) account becomes depleted, your client is required to notify Medicare that the medical settlement money has been properly depleted/administered correctly.
Q: How does The Experea Pharmacy Card help with required reporting to Medicare?
A: The Experea Pharmacy Card tracks all prescription purchases, available from the member services account online the following day. If the member does not have Internet access s/he may request her/his prescription reporting by calling Experea toll-free at 1-866-EXPEREA (397-3732) and we will mail the report for free.
Q: What happens after the member reports to Medicare that the Medicare (MSA) account is properly depleted?
A: Once the member shows Medicare that s/he has spent the money correctly, s/he will be eligible for Medicare coverage for injury-related treatments whenever the medical money runs out. Medicare Set-Aside (MSA) money must be properly depleted in order to use Medicare insurance.
Q: How can I help my client be sure to obtain pricing that complies with Medicare’s policy for Medicare Set-Aside (MSA) accounts?
A: While Experea is not a fund advisor, the following Medicare Policy links for a self-administrator are provided for your convenience and reference.
Information about prescriptions
Information about medical supplies, physician visits, surgeries
Download the Medicare Policy Form for additional, specific information about eligibility.
