To hear it from the pharmaceutical industry, Medicare Part D, the federal program that helps American seniors and the disabled cover medication costs, is a highly popular, successful, low-cost program. That’s bunk. According to a new paper, written by authors Marc-Andrew Gagon, PhD. and Sidney Wolfe, MD (Carleton University’s School of Public Policy and Administration and Public Citizen, respectively), drug prices covered under Medicare Part D are wildly inflated compared to drug prices in all other countries. Ok. We knew that already. That’s why seniors continue to import medication from other countries! But seriously, this report includes fresh data and critical analysis to reminds us, and hopefully convince Congress, that not only are we paying too much as taxpayers and consumers but Americans often cannot afford to take prescribed medication at all, and that leads to more hospitalizations and higher healthcare costs.

We’ve noted on many occasions the government’s survey data showing that about five million Americans import prescription drugs for personal use due to cost. About 750,000 are seniors, most who are subject to the coverage gap known as the “doughnut hole” of Part D, which, despite improvements under Obamacare, still leads to millions of seniors struggling to afford medication. Their decision to buy more affordable medication internationally makes sense. According to the new report, even the rebated brand name drugs under Part D are almost twice (198%) the cost paid in countries that make up the Organization of Economic Cooperation and Development (OECD) – the most advanced economies.

The report is called “Mirror, Mirror, on the Wall: Medicare Part D pays needlessly high brand-name drug prices compared with other OECD countries and U.S. government programs.” You can find it here. (more…)

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If you were to take a time machine and go back to 2006 and put a hundred bucks in a savings account with 5% annual interest, you’d have $147.50 in 2014. Not bad. But if your interest rate was tied to the annual price increases of brand name drugs you’d end up with…$202. And if for some crazy reason you just wanted to have the same purchasing power 8 years later, and tied your interest rate to inflation, you’d only end up with $125.

Clearly the increase of drug prices are out of line with the prices for everything else, and while the numbers figured above only take in to account brand name prices, generic prices are rising, too. On average, generics cost 5% more in 2014 than they did in 2013. That’s on average – some generic drug prices increased by 2,500 %!

But there’s good news on the way. Senators Sanders and Klobuchar are fighting for more affordable medication. Some more good news, at least for seniors, was released this past week. The Wall Street Journal reports that the Obama administration’s fiscal budget for 2016 calls for the government to negotiate prices for biologic and high-cost drugs for Medicare Part D. While, we’d like to see prices negotiated for all drugs, this can still represent huge savings for the government. Estimates suggest that 9.1% of national health spending could be on specialty drugs. That’s total health spending, not just drug spending.

We’re eager to see if the government will actually able to negotiate prices in 2016 – who knows how the budget will change or if Pharma will push to prevent negotiations. We’ll be keeping an eye on this and will certainly let you know.

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A Bittersweet Prescription

A Bittersweet Prescription

OPEN enrollment for Medicare Part D drug plans ended this past Sunday, but my thoughts about them linger. Our website www.MedicareDrugpPlans.com received about 150 ratings of part D plans in 2014 – most of them highly critical, and some of them downright scathing! Whether it’s a plan’s horrible customer service, lack of coverage of many brand name drugs, or dropped coverage, we’re hearing from many irate seniors. At the same time, some studies have shown most seniors are happy with their plans. Why all the contradictions about Part D? To understand, please join me on a trip down Part D memory lane.

When PharmacyChecker.com was founded in 2002, American seniors did not have pharmacy benefit plans through Medicare. While most seniors had some drug coverage through private health insurance or Medicaid, 25% were without any drug coverage and, thus, vulnerable to a pharmacy’s highest retail price. Just eight months after our website launched in April 2003, Congress passed and the president signed the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), which created a pharmacy benefit opportunity for all Medicare enrollees known as Part D.

It’s amazing and sad to report that, today, the problem of high drug prices for Americans overall is worse than the problems existing before the MMA was born. In 2001, the Commonwealth Fund reported that 28 million Americans did not fill a prescription due to cost. That number shot up to 50 million Americans in 2012!

(more…)

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Since open enrollment began two days ago, Medicare beneficiaries all over the country have been looking for new Medicare Part D plans. In fact, based on our analysis of recent Part D Reviews on MedicareDrugPlans.com, you’d think most enrollees were looking for new plans! Of the past 50 reviews on the site, this is what we found:

  • 44% had customer service issues, including unresponsive service, rude representatives, and billing and enrollment errors.
  • 42% complained about mail order issues, such as shipments taking too long, poor packaging and instructions, and poor website experiences.
  • 30% had problems prescribed drugs not being covered, inaccurate pricing, or coverage refusal after requesting authorization.

While we can’t say much about how to prevent dealing with mail order pharmacy or customer service issues, we know that you have the power to tackle formulary problems. Just so we’re clear, the way to find out which plans cover the drugs you need is at the government’s site, Medicare.gov – not on MedicareDrugPlans.com. MedicareDrugPlans.com serves as a listening board for what you need to look out for when you pick your plan, and is meant to be a supplement to the government’s site, so we recommend using both while selecting a plan. That way, you can make sure your drugs are covered and hopefully avoid any unforeseen issues.

Finally, it’s unfortunate that most of the reviews and ratings of Part D plans are negative ones. We want positive ones! We know that many Americans are benefiting from the plans. To whomever this applies: please help your peers by reviewing and rating the Part D plans that you like.

Good luck searching for the right plan!

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October 15th is just under two weeks ago, and while that date might not mean much to those not enrolled in Medicare, it marks the beginnings of open enrollment for Medicare’s Part D pharmacy benefits. That means that if you are looking for a new Medicare plan, you have until December 7th to do so. Even if you don’t think you need a new plan, you should check out what’s available, for a variety of reasons:

  1. Your plan may be discontinued, in which case, if you do not act, you might be transferred to a plan that is worse for you. There are 14% fewer plans in 2015 than there were in 2014.
  2. New plans exist, and they might be better than your current plan.
  3. Your prescription needs have changed. If you started taking a new medication in 2014 and it wasn’t covered by your current plan, or required you to spend more out-of-pocket than you expected, it might be time to switch to a plan that covers any new meds.

Our sister site, MedicareDrugPlans.com, can help you find a new plan. It compares premiums, deductibles, and even lets you know if drugs are covered during the coverage gap. More importantly, you can read reviews from enrollees who have actually signed up for these plans! Knowing the costs and coverage can only go so far, as these reviews tell us:

Alabama, TennesseeCigna-HealthSpring Rx –Reg12

“I have been trying to sign up for this plan but have a very hard time getting answers. Many of the telephone reps answer questions with “I don’t think so or I’m not sure” which is not helpful. They also require you to sign a statement that says “Humana has the right to change the program at any time if they notify the customer.” I have been told that this is just a formality but it makes me nervous.”

New YorkFirst Health Part D Value Plus

“I used this plan in 2013 and it was pretty good…most prescriptions cost me 0. But some prescriptions were not covered and I had to scramble to find the drugs elsewhere. Their cost per month was good, but now it is going up, and I will be switching to a cheaper monthly cost plan.”

Once you read reviews and compare plans on MedicareDrugPlans, head over to the government’s site, www.Medicare.gov, at which you can type in the drugs you take and find out which plans offer the best coverage for you. Using Medicare.gov and ratings from MedicareDrugPlans.com will help you make a fully informed decision. And don’t forget to leave a review on MedicareDrugPlans, so your fellow enrollees can learn from your experiences. Good luck finding the plan that is best for you, and don’t forget to enroll by December 7th!

 

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The journal Health Affairs recently published an article titled “Medication Affordability Gains Following Medicare Part D Are Eroding Among Elderly With Multiple Chronic Conditions.” The article is about changes in and problems with affordable access to medication for all Medicare enrollees who are 65 and over, not just those with chronic conditions. It focuses on two different time periods, 2007 to 2009 and 2009 to 2011. The data shows that while Medicare Part D initially improved access to affordable medication, some of those gains were lost, and for seniors taking the most medications, the most vulnerable, improvements may have disappeared entirely.

In 2005, before Part D plans were available, the study noted that an estimated 14.9% of seniors experienced cost-related problems accessing prescription drugs (meaning they did not take medicine as prescribed due to cost), also called cost-related prescription non-adherence (CRN). CRN decreased to 11.3% in 2007. Then, surprisingly, following the worst economic downturn since the Great Depression (during which the average wealth of the elderly dropped 20%), the number decreased further to 10.2%.

During the economic upturn, however, the CRN figures crept back up to 10.8 by 2011. The same trend – a decline then an increase – happened for the percent of seniors forgoing other needs to pay for medicine (such as food and heat): 8.8 percent in 2005, 5.6% in 2007, 4.0%, but back up to 5.3% in 2011.

The CRN numbers are much worse for seniors with four or more chronic conditions, such as diabetes, cancer, hypertension, and asthma, among others, representing about 27% of all beneficiaries. (more…)

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Last week, we reported on proposed changes to Medicare Part D that could have made it harder for millions of seniors to obtain prescribed medicine. One congressman from Pennslvania, Tim Murphy, went so far to say that suicide rates would increase as a result of the proposed changes, referring to a change that would have allowed insurers to reduce coverage for antipsychotics, immunosuppressants, and antidepressants. Other proposed changes included allowing the government to intervene in contracts between insurers and pharmacies, limiting the number of drug plans available, and also expanding access to community pharmacies.

Outcry from both sides of the aisle, as well as patient and consumer rights advocates, has resulted in the Obama administration reversing course on the changes. “We will engage in further stakeholder input before advancing some or all of the changes in these areas in future years,” wrote Marilyn Tavenner, Administrator of the Centers for Medicare and Medicaid Services.

We are glad specifically that coverage for critical medication will remain strong and that the number of drug plans will not be limited in certain areas. We know that the intention of reducing drug plans was to help make it easier to choose a plan. On the other hand, we support expanding access to community pharmacies and hope for further action on that front.

Fortunately, there are online resources that can help with this. Not all Medicare drug plans are created equal. PharmacyChecker.com runs MedicareDrugPlans.com, which you can use to compare plans and read or write reviews on those plans available in your area.

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Future Changes to Medicare Part D may curtail access to affordable medication for millions of seniors enrolled in Part D prescription drug plans, according to Kaiser Health News and USA Today.

The Obama administration wants to remove three drug classes, immunosuppressants, antipsychotics, and antidepressants, from the list of specially protected drugs. What this means is that insurers would no longer be required to cover the majority of these drugs in those classes. What that means is that more  patients will struggle to afford – and even skip – medications due to high out-of-pocket costs at U.S. pharmacies.

An alliance of Democrats, Republicans, drug companies, and patient advocates oppose the proposal. Rep. Tim Murphy, R-PA, who is also a psychologist, fears the worst: “If you restrict access to these drugs you restrict the treatment of mental illness,” he said. “You raise suicide rates.” Murphy’s sharp statement suggests just how important drug coverage for Medicare beneficiaries is. Over half of seniors aged 65 or older take at least five prescription drugs, and a carefully organized prescription plan may have disastrous side-effects if a drug is switched for another. Such substitution would likely occur for many patients if drugs are removed from special protection. (more…)

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Your prescription drugs will never be free under Medicare Part D. The “closed” donut hole under Obamacare does not create a new coverage period under Part D during which your co-pays and co-insurance, not to mention deductibles and premiums, disappear. That’s not a reason to complain. We should shoulder costs for our healthcare, including medication, as long as they are affordable (after all, Obamacare is actually called the Affordable Care Act). So how does Obamacare strive to help you afford your prescription drugs if you’re on Medicare? First, a little history…

In the beginning, Medicare did not offer a prescription drug benefit and tens of millions of seniors paid for their medications entirely out-of-pocket. Let there be light: In 2003, Congress passed the Medicare Modernization Act, which was then signed into law by President Bush. That law gave birth to Part D – a prescription drug benefit available to Medicare enrollees. But there were holes! When Medicare Part D plans first launched in 2006, average monthly premiums were $25.93. After paying a standard deductible of $250, enrollees paid 25% of their drug costs until total drug costs (between the enrollee and insurer) reached $2,250. That’s $250 towards the deductible, $500 in cost-sharing, plus premiums of $311.16 for a total of $1,061.16 per year in out-of-pocket spending. That’s if you stayed out of the donut hole!

Enter the dark days of the “donut hole,” which, in 2006, meant 100% out-of-pocket spending between $2,250 and $5,100 – Ouch!  Above $5,100 – an amount called, for good reason, “catastrophic costs” –enrollees only paid 5% of their drug costs. Part D maintained these basic components, except with rising costs in the form of higher premiums and deductibles, and a larger “donut hole,” until the passage of the Patient Protection and Affordable Care Act in 2010 – enter Obamacare (hope and change?).

(more…)

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How Your Medicare Part D Co-Pay Changes Can Impact You

We’ve been writing about upcoming changes in Medicare Part D on this blog for the past few weeks. Last week, we pointed out some significant changes to deductibles and premiums but those aren’t the only cost-related changes you have to worry about. Your current plan’s co-payment (flat fee) or co-insurance (percentage fee) may also change in 2014, greatly impacting your wallet unless you change your plan.

Medicare Part D plans often categorize drugs by “tier,” and all drugs within a tier have the same cost-sharing. Today, we’re going to focus on upcoming changes to cost-sharing within a tier.

One notable change is to Aetna Medicare Rx Premier’s preferred brand co-pay when purchasing meds from in-network pharmacies. For many states, the plans’ 2013 co-pay was $99 for a 90-day supply of medication. But in 2014, Aetna’s co-pay in this tier will be replaced with co-insurance to the tune of 25% of a drug’s cost,  which can mean much higher costs for you. For instance, the cholesterol drug Crestor, which was in this tier in 2013, costs around $600 for a 90-day supply. In 2014, that could cost somebody with this plan $150, instead of just $99, a 50% increase!

Other plans have simpler changes, and some are even good, like those to First Health Part D Essentials. This plan is available in many states, but we’ll specifically look at the plan’s changes in Connecticut. The co-insurance for using the plan’s mail order pharmacy for preferred brand-name drugs drops 40%, from 25% to 15%. This is great if you’re buying a preferred brand name drug. But in order to make up for the savings on preferred meds, the co-insurance for non-preferred brands rises slightly, from 42% to 44%. Although the difference is only 2% of the drug’s cost, it can add up quickly when applied to multiple medications.

To make things even more complicated, a plan’s changes can vary from state to state. The First Health Part D plan mentioned above actually has a lower non-preferred brand co-insurance in a few states. In Illinois, the co-insurance drops from 50% to 47%.

These few examples of cost-sharing changes to Part D plans show you the importance of doing your research. Your plan may have specific changes not mentioned here, but the only way to find out is to look at its details for 2014. If you are thinking about checking out new plans, head over to MedicareDrugPlans.com, where you can read reviews and see ratings left by plan members.

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