The LA Times is reporting that some rx’s are costing more under Medicare D(isaster)!!!

Martin Brower was reluctant to enroll in Medicare D(isaster), but he did.  When he went to pick up his rx’s, he found out that they would actually cost him more than he had paid w/o Medicare D!

When Brower, 77, plunked his official card on the counter at Costco to pick up his regular prescription, however, he got some disturbing news: His monthly supply of blood pressure medication would cost less if he didn’t use his Medicare plan.

The plan allowed him a maximum of 30 pills for $1.32 each. Without it, he could get 100 pills for $1.13 apiece.

Brower is no longer using Medicare D(isaster), as the plan saves him nothing.

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Seniors who are reasonably healthy, middle-class and do not take a lot of expensive rx’s — realize that after premiums, co-payments, coverage gaps and other costs are figured in, the Medicare D(isaster) drug prices are little better, and sometimes worse, than prices at a lower-budget pharmacy.

Former president of the California Pharmacists Assn., Ralph Saroyan, assumed that he chose the best plan for his mother as she needs some expensive DAW rx’s. However, that Medicare D(isaster) plan’s  affiliated pharmacy claimed its reimbursement wasn’t enough to cover name brands, only generics.  In addition, Saroyan realized that the co-pays were $18 for each monthly maximum of 30 pills, plus the monthly cost of the premiums. If those rx’s were purchased w/o Medicare D(isaster) they would cost $25.

Pharmacists are unable to tell what a plan’s so called “negotiated price” is until the rx billing is entered into a computer. Prices vary according to which plan, which formulary, if a rx is obtained via mail order, and if it is generic.

A review by the Senior Action Network, a grass-roots advocacy group in San Francisco, found that Costco’s prices on the top 100 drugs used by Medicare beat prices of all 48 plans in California in more than half the cases.

According to David Grant, the network’s health policy director,

“Seniors still ask, ‘How come the drugs cost more with insurance than if I just go to Costco and buy them?’ ‘Why is it better to pay more and get less?’ “

According to a report released by Henry Waxman,

Prior authorization requirements, step-therapy provisions, and volume limits by the vast majority of Medicare drug plans restrict access to formulary drugs. The Medicare data show that 97% of plans place either prior authorization or step therapy requirements on at least one of the 100 most popular drugs, with the average plan restricting access to over 10% of the popular drugs listed in its formulary.

This is what troubles most people, as is the requirement of Medicare D(isaster) that a person try generic rx’s, as opposed to what his/her dr. wishes to prescribe.
In addition, a Washington Post-ABC poll, discovered less than a third said they were saving a lot, and 26% said there were no savings.

CMS still insists that millions are saving money, and Medicare D(isaster)’s value can’t be measured strictly comparing rx prices, but also must include insurance coverage against illness/injury.  Also, according to Leslie Norwalk of CMS,

The plans offer “meaningful and affordable” coverage and catastrophic insurance protection for as little as $2 per month in some states.

If one’s rx costs are more than $2,250 a year, he/she lands in the “doughnut hole,” and would be fully responsible forresponsible for the list price for rx’s. Under most Medicare D(isaster) plans, the “donut hole” is in effect until a one spends up to $5,100.  38% of all enrollees would fall into the “donut hole”, according to a study by the Commonwealth Fund, a nonprofit, nonpartisan foundation.  The study also found that only 14% are expected to need catastrophic coverage.

Smaller surveys have found that better discounts overall are available outside of Medicare, such as at Costco, Drugstore.com, and particularly in government programs operated by the Department of Veterans Affairs and Medicaid, which negotiate volume discounts.

In January, the Democratic staff of the House Committee on Government Reform found that some Medicare D(isaster) plans were charging more for 10 top brand-name drugs that averaged 2% more than at Costco in Los Feliz, 4% more than at Drugstore.com, 61% more than in Canada (which caps prescription prices) and 78% more than the other federal programs.

Stephen W. Schondelmeyer (a professor of pharmaceutical management and economics at the University of Minnesota) discovered that Medicare plans’ prices did not differ much from those of typical retailers in one Minnesota ZIP Code.

AARP spokesman Steve Hahn,

“Not all plans will be cheaper all the time, but we’re looking at the overall mix and the value of the insurance. It’s very difficult to come up with a program for 44 million that would provide the corporate coverage you or I are used to for $5 to $10” co-payments.

 

No, it is not!  Four words:  SINGLE PAYER HEALTH CARE!!!

Here is another suggestion, Steve, address this: This is the second time LA Times noted that the AARP endorses the AARP MedicareRx Plan, operated by UnitedHealthcare and obtains undisclosed royalties for enrollments.  Earlier, Larry Noble, executive director of the Center for Responsive Politics, has called for the AARP to make a full financial financial disclosure regrading that marketing arrangement.