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

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.