by Gabriel Levitt, Vice President, PharmacyChecker.com and Sam Werbalowsky, Pharmacychecker.com | Aug 8, 2014 | Medicare Drug Plans, Medication non-adherence, Skipping medications
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…)
Tagged with: cost-related non-adherence, CRN, Health Affairs
by Gabriel Levitt, Vice President, PharmacyChecker.com and Sam Werbalowsky, Pharmacychecker.com | Mar 12, 2014 | Drug Prices, Healthcare Reform, Medicare Drug Plans
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.
Tagged with: Marilyn Tavenner, Medicare Part D, medicaredrugplans.com, Tim Murphy
by Gabriel Levitt, Vice President, PharmacyChecker.com and Sam Werbalowsky, Pharmacychecker.com | Mar 6, 2014 | Drug Prices, Healthcare Reform, Medicare Drug Plans
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…)
Tagged with: Medicare Part D, Tim Murphy
by Gabriel Levitt, President, PharmacyChecker.com and Prescription Justice | Dec 6, 2013 | Drug Prices, Healthcare Reform, Medicare Drug Plans
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…)
Tagged with: donut hole, Medicare Part D, Obamacare
by PharmacyChecker.com | Nov 8, 2013 | Medicare Drug Plans
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.
Tagged with: Crestor
by PharmacyChecker.com | Oct 30, 2013 | Medicare Drug Plans
As we wrote a few weeks ago, there are loads of changes coming to Medicare Part D next year. Changes to your plan’s deductible and monthly premium can impact your wallet, for better or for worse! We’ve analyzed the plans from 2013 and 2014 and identified those with notable changes to their deductibles and premiums.
Keep in mind that there may be other important changes to a plan, such as those to its formulary or cost sharing structure. For example, the deductible for Blue MedicareRx Value plan double in 2014, and it is also losing about 700 drugs from its formulary. On the other hand, this plan and others might see increases in deductibles or premiums correspond with lower co-pays or better donut hole coverage, which could save you a lot of money.
The tables below show you examples of plans with large changes, and aren’t meant to be comprehensive. To view more plan options, and read reviews and ratings by members, head over to MedicareDrugPlans.com.
Notable Decreases in Plan Deductibles
| Plan Name |
States |
2013 Deductible |
2014 Deductible |
Dollar Change |
% Change |
|
Express Scripts Medicare – Choice (PDP)
|
Many States |
$200 |
0 |
-$200 |
-100% |
| Health Alliance Medicare Prescription Plan – Enhcd (PDP)
|
Illinois |
$325 |
0 |
-$325 |
-100% |
| United American – Enhanced (PDP) |
Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Wyoming, |
$40
|
$20 |
-$20 |
-50% |
Notable Increases in Deductible
| Plan Name |
States |
2013 Deductible |
2014 Deductible |
Dollar Change |
% Change |
| Blue MedicareRx Value (PDP)
|
Arizona |
$150 |
$310 |
$160 |
107 % |
| Prescription Blue Option A (PDP)
|
Michigan |
$125 |
$195 |
$70 |
56% |
| Blue Rx Plus (PDP)
|
Pennsylvania, West Virginia |
$250 |
$310 |
$60 |
24% |
Notable Decreases in Monthly Premiums
| Plan Name |
States |
2013 Premium |
2014 Premium |
Dollar Change |
% Change |
| WellCare Classic (PDP)
|
Mississippi |
$36.60 |
$17.30 |
-$19.30 |
-53% |
| Aetna Medicare Rx Essentials (PDP)
|
Oregon, Washington |
$72.90 |
$35.20 |
-$37.70 |
-52% |
| Express Scripts Medicare – Choice (PDP) |
Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota |
$102.70 |
$70.60 |
-$32.10 |
-31% |
Notable Increases in Monthly Premiums
| Plan Name |
States |
2013 Premium |
2014 Premium |
Dollar Change |
% Change |
| Aetna CVS/pharmacy Prescription Drug Plan (PDP)
|
Florida |
$32.50 |
$75.00 |
$42.50 |
131% |
| AARP MedicareRx Saver Plus (PDP)
|
Oregon, Washington |
$15 |
$29.50 |
$14.50 |
97% |
| First Health Part D Value Plus (PDP)
|
Colorado |
$32.30 |
$58.40 |
$26.10 |
81% |
Once again, you need to shop around and do your research to get the best plan. Check out some reviews and ratings at MedicareDrugPlans.com – and rate your current plan to help others – then head over to the government’s site www.medicare.gov to compare plan formularies, and choose a plan that covers the medications you take.
Tagged with: 2014, deductibles, Medicare Drug Plans, Medicare Part D, premiums
