A new analysis of the highest and lowest prices of ten of the most frequently prescribed brand name drugs found extreme price variations among Medicare Part D drug plans, according to a new analysis released by The Senior Citizens League.
"One look at the price comparison chart illustrates why Medicare beneficiaries need to check and compare drug plan prices during this fall's Medicare's Open Enrollment," says Mary Johnson, a Medicare policy analyst for The Senior Citizens League.
There can be more than a thousand dollars in price difference among drug plans for the very same drug, the analysis found.
In addition, due to recent legislative changes that limit the co-insurance charged during the "doughnut hole" stage of coverage, some brand name drugs are now less expensive in the "doughnut hole" than in the initial coverage stage, where costs are typically the lowest.
"Because Medicare isn't negotiating prices on our behalf, there's no consistency in drug pricing among Medicare Part D drug plans," says Johnson, who performed the comparisons using the Medicare website's Drug Plan Finder. The disparity in pricing is highest when the drug isn't listed on the plan's formulary or list of covered drugs.
The diabetes drug Novolog Flexpen, for example, had a low price of $37 and a high of $2,012 in a plan where the drug is not on the formulary.
A monthly supply of Lyrica, which is used to treat the nerve and muscle pain of fibromyalgia and seizures, costs a low of $37 and a high of $178. The $178 is higher than what drug plan enrollees would pay in the "doughnut hole" coverage-gap phase, which is $155.
In 2019, enrollees will pay 25 percent co-insurance for covered brand name drugs in the doughnut hole. However, in a number of plans, initial coverage co-insurance for top formulary tiers can be as high as 50 percent, which would be twice as much as the doughnut hole in 2019.
In one case, the comparison found the cost of the drug was driven up when the high drug plan premium was factored in. For example, Voltaren Topical Gel ranges from $28 to $37 per month. However, the plan in which the drug cost the least had an unusually high premium. Once the premium of $159 was added to the $28, the total cost was $187 ($28 + 159), versus $63 for the lowest-costing plan ($37 + 26).
"Most people 65 and over take more than one prescription drug. To get the lowest-cost and best plan, people need to compare plans based on all the drugs they actually take," Johnson explains. "The Medicare Drug Plan Finder shows the combined cost of drugs and the premium with the lowest costing plan shown first. In addition, consumers should carefully compare prices between in-network walk-in and mail-order pharmacies - those prices can also vary," Johnson notes.
Information on all drug plans, premiums and drug costs can be found on the Medicare Drug Plan Finder at www.Medicare.gov. The drug plan finder allows personalized searches based on the drugs one actually uses.
Comparing plans doesn't have to be a mind-numbing chore.
Medicare beneficiaries can get free one-on-one counseling from State Health Insurance Program (SHIP) counselors by contacting your local Area Agency on Aging or senior center. SHIP contact info can be found at https://www.shiptacenter.org
Medicare beneficiaries can compare plans and make changes during Medicare Open Enrollment, which runs October 15 - December 7, 2018.
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