Rick, you said "The Medicare part d inconsistencies drives me crazy. How about the same plan for all?..." and @bamaqueen said her Advantage Plan doesn't cover Arikayce either.

Please, please, pleas bombard your Representative and Senators with these examples of inequity in Medicare, which was supposed to protect us all in our senior years. Ask them to clamp down on the insurance industry with all of its fancy-named plans to enrich them, not serve us.

Specifically, Advantage Plans came about because the insurance companies complained about needing a cheaper way to bring people in - they are paid a certain amount per year by Medicare for each enrollee, and that's all they get. So the more times they say "No" to a procedure or a referral the less money they pay out.

The drug issue is an even bigger issue. "Formularies" are agreed on each year by insurance companies and Pharmacy Benefit Managers (PBM's) - which are often owned by the insurance companies - creating Tiers of drugs with generics being cheapest, the newest patented drugs and biologics the most expensive.
Each insurance company sets the co-pays and "prior authorization" requirements for medications, then turns it all over to a tightly controlled group of people (who may or may not be medically trained) to run the process.

My insurance company changed PBM's this January, and medications my husband and I had been taking for a long time to manage chronic conditions had to be reauthorized - on first submission, both were denied as "not medically necessary" - appeals restored both prescriptions "for one year only." No person signs and can be held accountable for these authorizations. My daughter's PBM wants to authorize her biologic every 3 months, even though it is for a disease she'll have the rest of her life. Her latest kerfuffle with them caused a 4 month delay, forcing her back on high doses of prednisone - which she will probably pay for in her future with osteoporosis. I was just prescribed a new prior approval drug today, after having failed the conservative protocols. I will be watching closely to see how soon approval comes.

If you read around Connect, you will see we all need to lobby for change - with the people who regulate this, and not just amongst ourselves.