Medicare doesn't have the authority to negotiate drug prices, leaving millions of older Americans at risk of price gouging for their prescription drugs, according to a new comparison of drug plans by The Senior Citizens League (TSCL).
"Because Medicare isn't negotiating on our behalf, there's no consistency in drug pricing among drug plans," states TSCL's Medicare policy analyst, Mary Johnson, who performed the comparisons using the Medicare website's Drug Plan Finder. Costs vary enormously between plans. "The disparity in pricing for the same drug can be in the hundreds of dollars," says Johnson.
TSCL was stunned to learn just how big the disparity in drug prices can be. Johnson compared the highest and lowest prices of the top ten most-prescribed drugs in the U.S. using the Drug Plan Finder found on the Medicare website. The overall average cost difference between the highest - and lowest - cost plans for the top ten drugs was $593 per month. Johnson's comparison used one zip code as a control since prices vary depending on the part of the country where an individual lives, as well as between plans. In Johnson's zip code she had 23 plans to compare.
A monthly supply of diabetes drug Lantus Solostar, for example, ranges from a high of $682.00 from the mail order pharmacy of First Health Part D Value Plus plan to a low of $77.75 from the network retail pharmacies for SilverScript Choice, a difference of $604.25 per month. "Most people 65 and over take more than one prescription drug, so to get the lowest-costing plan that's right for you, people need to do a drug plan comparison based on all the drugs they currently take, " Johnson explains. "In addition, you should carefully compare prices at network retail pharmacies as well as mail order - those prices can also vary significantly," Johnson notes.
The costs shown in the chart below assumed plan coverage started on September 1, 2017 for a new enrollee. The Medicare Drug Plan Finder cost estimates include premiums, and out-of-pocket cost sharing for 2017. Costs shown are estimates and the actual costs may vary somewhat depending on pharmacy used. The prices illustrated in the chart are likely to change for 2018.
|Part D Plan Price Variation of the Top 10 Most-Prescribed Medicines in 2017|
|Drug||Generic||Lowest Price Per 30 day supply||Highest Price Per 30 day supply||$ Difference||% Difference|
|Snythroid (levothyroxine)||Generic price shown||$17.00 Humana Walmart Rx Plan (mail order)||$151.50 Anthem Blue Medicare Rx Premier (retail or mail order)||$134.50||791%|
|Crestor (rosuvastatin)||Generic price shown||$27.25 WellCare Classic (mail order0||$383.50 Express Scripts Medicare - Value (mail order)||$356.25||1307%|
|Ventolin (albuterol)||No generic||$70.00 Humana Walmart Rx Plan (retail)||$189.00 Anthem Blue Medicare Rx Premier (mail order)||$119.00||170%|
|Nexium (esomeprazole)||Generic price shown||$60.00 Cigna-HealthSpring Rx Secure (retail)||$471.75 Anthem Blue Medicare Rx Plus (mail order)||$411.75||686%|
|Advair Diskus (fluticasone)||No generic||$85.50 First Health Part D Value Plus (retail)||$856.25 Symphonix Value Rx (mail order)||$770.75||901%|
|Lantus Solostar (insulin glargine)||No generic||$77.75 SilverScript Choice (retail)||$682.00 First Health Part D Value Plus (mail order)||$604.25||777%|
|Vyvanse (lisdexamfetamine)||No generic||$175.25 AARP Medicare Rx Preferred (retail)||$618.25 Anthem Blue Medicare Rx Premier (mail order)||$443.00||253%|
|Lyrica (pregabalin)||No generic||$77.75 SilverScript Choice (retail)||$521.25 AARP Medicare Rx Walgreens (retail)||$443.50||570%|
|Spiriva Handihaler (tiotropium)||No generic||$166.75 First Health Part D Value Plus (retail)||$2,159.75 SilverScript Plus (mail order)||$1,993.00||1195%|
|Januvia (sitagliptin)||No generic||$77.75 SilverScript Choice (retail)||$732.50 AARP Medicare Rx Saver Plus (mail order)||$654.75||842%|
Source: Medicare Drug Plan Finder, www.Medicare.gov
"People should watch for mail from their drug or health plans explaining cost changes for 2018," Johnson says. You can compare plans and make changes during the Medicare Open Enrollment period, which runs October 15th through December 7th. You can get free one-on-one counseling from your state Health Insurance counselors (SHIP) by contacting your local Area on Aging, or senior centers. Ask for help comparing Medicare drug plans. TSCL strongly supports legislation that would allow Medicare negotiation of drug costs.
With 1.2 million supporters, The Senior Citizens League is one of the nation's largest nonpartisan seniors groups. Its mission is to promote and assist members and supporters, to educate and alert senior citizens about their rights and freedoms as U.S. Citizens, and to protect and defend the benefits senior citizens have earned and paid for. The Senior Citizens League is a proud affiliate of www.trea.org The Retired Enlisted Association. Visit www.SeniorsLeague.org for more information.