A new analysis from The Senior Citizens League (TSCL) of 12 frequently – prescribed drugs illustrates that Medicare recipients frequently overpay for their medications. “Because Medicare doesn’t negotiate drug prices there are wild swings in prices between Part D drug plans,” says Mary Johnson, The Senior Citizens League’s Medicare and Social Security policy analyst. The difference in cost for the same drug between drug plans can be in the thousands of dollars for the most expensive drugs, and hundreds of dollars for more common prescriptions. Since the start of Medicare Part D in 2006, Johnson has volunteered to help friends and acquaintances shop for Part D plans.
Although Medicare has an annual Open Enrollment period, when beneficiaries can compare drug plans and switch to lower costing drug plans, few retirees actually do so. “In most areas of the country, the Medicare beneficiaries have more than two dozen Part D plans to sort through, and the average person just don’t know where to begin, or that free, unbiased help is available,” Johnson says. “Consequently, Medicare beneficiaries winds up overpaying for prescriptions that could be obtained for a lower cost from a different drug plan.”
Johnson compared the lowest and highest cost between drug plans for a list of 12 frequently – prescribed drugs. The list includes commonly prescribed brand name and specialty drugs, as well as two widely – used generics. The analysis found:
The difference in drug prices between the lowest and highest costing plans, can be in the hundreds, or even thousands, of dollars.
For brand name and specialty drugs, the most frequent reason that the drug costs so much more in the highest costing plan is lack of coverage. The drug is not listed on the high cost plan’s formulary. For example, the lowest cost plan for Sovaldi, a drug used to treat Hepatitis C, charges $5,600 in co-insurance (for a one-year treatment). The highest cost drug plan charges $100,800, the full cost of the drug, because Sovaldi is not on the plan’s formulary.
New Part D plan drug pricing programs may lower costs for those who seek out the savings.
Recent Congressional scrutiny on drug pricing may be spurring some drug plans to drop prices. One of the biggest cost-savings found is a new drug plan pricing program that lowers the cost of insulin. In the 2018, the lowest cost Part D plan charged an $80 copay for a 100/ML of Lantus Solostar. In 2019, a different plan had lowest cost copays charging as little as $6.00 – $11.00 for Lantus Solostar, in the Cigna-HealthSpring Rx Secure — Extra Part D plan. The highest cost plan, which does not cover Lantus, charges the full price, $383.18 per 100/ML.
High premiums don’t necessarily purchase better coverage.
The generic blood pressure medication, Lisinopril, is one of the most commonly used prescriptions by Medicare beneficiaries. The least expensive Part D plan charges $0 copay for the drug, and the plan’s monthly premium is just $14.50 in the zip code used in the analysis. The most expensive plan charges a co-pay of $9.19, and the plan has a monthly premium of $93.30. Counting premiums, that’s a difference of $1,055.88 for the entire year.
“To avoid overpaying for prescriptions, and to find the most affordable coverage, the importance of comparing drug plans during one’s initial enrollment in Medicare, and during Medicare’s annual Fall Open Enrollment period October 15th -December 7th can’t be overstated,” Johnson says. Most people 65 and over take more than one prescription drug, and to get the best plan, consumers need to compare plans based on all the drugs they actually take. In addition, consumers should compare prices between pharmacies, including mail order, which can also vary.
Free one-on-one assistance is available to help compare and select plans through state health insurance assistance programs. Many of these programs operate through Area Agencies on Aging, or senior centers. Local program contact info can be found at: Shiptacenter.org.
The Senior Citizens League is working for enactment of legislative measures that would lower prescription drug costs. To learn how to get involved, visit SeniorsLeague.org.