Medicare Drug pricing

Medicare Drug Coverage Will Be Pricier Next Year
Posted by Jacob Goldstein
Seniors will pay more to get prescription drug coverage from Medicare next year. The feds said so last month, but a new report from the consulting shop Avalere Health parses the numbers a bit differently, and suggests that the rise will be a bit steeper than the feds suggested.

The WSJ has the story. Among the report’s findings:

The average premium for all standalone drug plans will increase 24%, to $37 a month, up from $30 this year.
The average premium for the 10 most popular plans will rise 31%.
There’s wide range of price increases. The premium for Humana’s popular basic plan will rise to $40.83 in 2009 from $25.52 this year, an increase of more than 50%. But UnitedHealth’s AARP “preferred” plan, another popular option, will rise by 15.5%, to $37.
Seniors who can’t manage a price increase should shop around this fall; even if your plan’s premium is going up, there may be a cheaper plan out there that would work for you. Insurers will start advertising their plans Oct. 1, and the six-week enrollment period begins in mid-November.


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my wife and i only take generics. #4.00 at wall Mart ,so if the encrease for the plan goes up 20 or 30%, i will just cancel my plan.

Comment by justin deoliveira - September 26, 2008 at 9:06 am
Agree with Justin. Hit the $2500 medigap because I had $4 copay but druggist charged insurance another $20. Found 9 of my 10 meds were generics, $4 each at Walmart. Will cancel the prescription plan.

Comment by George Westmoreland - September 26, 2008 at 9:20 am
Is there a reason the biggest purchaser of medicines in the U.S. does not bargain with the pharmaceutical companies?
The VA does and saves signifcant money (and does not compromise the health of their patients. Maybe the US could have Wall Mart manage medicare part D.

Comment by richard reimer - September 26, 2008 at 9:25 am
$4..target also ..and we get our lipitor from india…works great except we are both wearing sari`s now!

Comment by bil - September 26, 2008 at 9:39 am
Law prohibiting Medicare price contracting with Big Pharma and the failure to use generic drugs when equivalent is the cause of this increase in cost of Part D. What about “the least of our brethren?

Comment by Victor L Kovner MD FACP - September 26, 2008 at 9:46 am
Walmart is destroying the retail pharmacy industry. They are doing what walmart does and that is bringing down small shops in any market they move into. Walmart is causing job loss which is fueling the economies downward spiral.

Please don’t jump the gun in canceling your prescription coverage, its called insurance for a reason. You never know what may happen and not every generic is $4.00s at walmart. Plus your doctor may believe that you need a brand name drug is what will save your life, then you will be wishing you had your insurance.

Comment by mike - September 26, 2008 at 10:15 am
Staying away from the medicare,pharmacy, and the doctors office. My husband and I both have been using the monavie active for about 4 months now and are having wonderful results more energy that is not pitched during the day but is fresh and steady. The monavie has seems to have helped my husband with his shoulder too he now can sleep better with no pain in his shoulder keeping him up at night, he fought this for about 3years all they the doctors would talk about is surgery and shots he started with monavie and it was all gone, all i would say is this product is worth a try and using it seems to have worked for us very well, we purchased ours on a website www.mymonavie.com/ctconrad just make sure you keep it in the fridge once you open it. hope this helps you out. God Bless.

Comment by retiredfornow - September 26, 2008 at 1:14 pm
The post show the confusion and misunderstanding of both health care and insurance. Insurance was never intended to cover all the cost and Wal Mart can’t fill every prescription with a generic for $4.00.I would advise everyone to look at the price they are paying for their other drugs. That $4.00 might not be such a value. What many people don’t know,even though the governmet does not get the best price, the Pharmacy Benefit Plans do and no one knows how much. Lets also deal in facts, no PBM is playing a pharmacy $24.00 for a $4.00 at Wal Mart.

Comment by Clinical Pharmacist - September 26, 2008 at 6:21 pm
I have never paid one red cent to medical “science.” And I’m 65. I believe doctors are the agents of the devil and you are committing the greatest sin of idolatry by going to them. God says He’s healer and to go to him in James 5:14. Doctors aren’t metnioned. They are the real quacks! They did not take the beating Jesus Christ did so you could be healed. But go ahead and spend over 1 trillion a year and get sicker! Spend most of it in the weeks before you die, YOU STUPID COWARDS!

Comment by Harold Reimann - September 28, 2008 at 1:19 pm
Oh, I forgot where you can go for the truth. eli3.tripod.com.

Comment by Harold Reimann - September 28, 2008 at 1:19 pm
Harold Reimann,

May god help you! You need all the help you can get.

And when your day comes, do us all a favor will you, squirm into your corner and die your death. Please don’t relent on your certain beliefs and go see a doctor or a hospital.

Comment by Anonymous - September 28, 2008 at 2:32 pm

Medicare Premiums 2009

For Most, Medicare Premiums Won't Rise in 2009
Medicare premiums will hold steady in 2009 for the vast majority of the 44 million U.S. beneficiaries, the first time since 2000 that rates haven't gone up.

Monthly premiums for about 95 percent of elderly and disabled Medicare recipients will be $96.40 next year, the Centers for Medicare and Medicaid Services reported Friday.

The announcement may seem surprising, given the fact that medical costs continue to outpace inflation. But Medicare officials said many unusual factors contributed to what will be just the sixth year without a premium increase since Medicare began in 1965.

Premiums have risen in recent years - more than 17 percent in 2005 - in part because Medicare had to build up reserves to offset changes made by Congress to adjust physician payments. Those reserves finally have reached adequate levels.

"It was painful to catch up, but now we have one year in which we can get rid of the catch-up amount and use that to offset the premium increases that otherwise would have happened," said Richard Foster, Medicare's chief actuary, estimating that next year's increases would have been about 8.5 percent.

In addition, the government also discovered an accounting error that benefits next year's rates.

Read Full Article (SFGate)

Medicare Fix payments

Because Medicare payments fixed and insurers, the only way primary care doctors can generate revenue is to take on more patients, which means spending less time with each—often no more than 15 minutes. “The commonest complaint you hear from patients is: ‘I don’t have enough time with the doctor yo dicuss  conditions in 15 minutes.”

Medicare Advantage Plan cost to taxpayers

Medicare Advantage Plans Cost $8.5 Billion More than Traditional Medicare in 2008
Private Medicare Advantage (MA) plans will be paid an average 12.4 percent more per enrollee in 2008 compared to what the same enrollee would have cost in the traditional Medicare fee-for-service program. The cost to Medicare, according to a new report from The Commonwealth Fund, will be $8.5 billion in 2008, pushing the extra cost from 2004 to $33 billion.

Even if the payment reductions to MA plans mandated by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) – scheduled to take effect beginning in 2010 – had been fully in place in 2008, MA plans still would have been paid 10.6 percent more than expected fee-for-service costs.

Extra payments to MA plans will amount to $986 over fee-for-service costs for each of about 8.7 million Medicare beneficiaries enrolled in Medicare Advantage plans, according to the estimate by Brian Biles, professor of health policy at George Washington University, and colleagues.

The total will be more than $8.5 billion in 2008 – up from $3.9 billion in extra payments, or $795 per MA enrollee in 2004. Extra payments to MA plans between 2004 and 2008 will total nearly $33 billion.

The bulk of these extra payments were mandated by the Medicare Modernization Act of 2003, which was intended to expand the role of private plans in Medicare in an effort to reduce growth in Medicare spending. Since 2004, MA plan enrollment has increased from 4.8 million to the current 8.7 million.

Read Full Article (SeniorJournal.com)

Marketing Prescrription Drug Benefit

September 5, 2008, 8:50 am
Marketing of Medicare Prescription Drug Benefit Is a Mess
Posted by Jacob Goldstein
Seniors who’ve tried to wade through all the marketing brochures for Medicare prescription drug plans know how confusing they can be. As it turns out, those brochures do a pretty poor job of meeting the guidelines laid out by the feds.

A report out yesterday from the inspector general’s office in the Department of Health and Human Services found that 85% of marketing materials didn’t meet guidelines set out by the Centers for Medicare and Medicaid Services. Whoops.

The report puts part of the blame on CMS; the model marketing documents CMS gave to insurers isn’t consistent with the agency’s own guidelines, the report says. The template doesn’t include required information on the subsidy available to beneficiaries with low incomes, for example. CMS says it has made corrections to its model documents.

Another problem is that most marketing documents that are produced by an insurer in conjunction with a pharmacy fail to mention — as required — that other pharmacies are also available.

The problems have some folks in Congress pretty peeved. “This report reveals a near-total failure by CMS, where officials have insisted that they can regulate the marketing of plans to seniors as well as or better than experienced state insurance agencies,” Sen. Max Baucus, a Montana Dem who has been active in policing Medicare marketing, said in a statement yesterday. “The evidence now shows that’s not the case.”

Photo by Aaron Fulkerson via Flickr

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bush and mcsame should be proud of this horlick

Comment by SICKETTE - September 5, 2008 at 9:57 am
It is sad that a program so many people need is being abused by those only looking for a quick buck.I could have made more money selling these plans than filling prescriptions and providing patinet care. CVS knew what they were doing when they purchased Caremark. Now many people think they have to go to CVS if they have a CVS Caremark plan. Maybe one day people will learn how to think and not allow all of these abuses to continue under the guise of free enterprise.

Comment by COMMUNITY PHARMACIST - September 5, 2008 at 5:23 pm
Interesting that this article points out the lack of meeting guidelines AND the WSJ article that mentioned marketing materials that failed to meet the guidelines completely GLOSSED OVER the fact that not only does CMS provide the templates for said marketing materials but they must also approve any and all marketing materials sent out by healthplans. Hmmm……..

Comment by healthplan employee - September 5, 2008 at 6:12 pm
There are too many plans to choose from. It’s confusing to just about anybody. There should be 3 plans - basic, medium, high. Also, the aggressive marketing makes it even more confusing. Also, formularies are not readily available to the patient, the doctor and the pharmacist to review. The way it is now, the Medicare prescription drug benefit is free enterprise out of control. It needs to be controlled, at least a little bit.

Comment by Primary Care Physician - September 5, 2008 at 8:04 pm
I agree that figuring out Medicare Part D is too confusing for the average senior but:

1) Before Medicare Part D most seniors had no access to coverage for prescription drugs whatsoever

2) anyone with access to Medicare.gov can figure out within a few minutes which plan will equate to the lowest out-of-pocket expenses, assuming the person’s prescriptions don’t change.

A decent insurance agent or non-profit organization can help seniors determine which plan makes the most sense every year, since they can change dramatically

Comment by orcamansam - September 6, 2008 at 1:24 am
hey primary care physician above,
are you voting for bush-mcsame?

Comment by donut hole - September 6, 2008 at 7:56 am
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Medicare Donut hole

September 2, 2008
Editorial
Medicare’s Troubling Drug Gap
Probably no aspect of the new Medicare drug program has caused more confusion and irritation than the notorious “doughnut hole,” a gap in coverage that forces people who had been getting their drugs cheaply to suddenly pay the full price out of pocket. Now, for the first time, an analysis has quantified what happened last year when millions of beneficiaries fell into the gap. For patients with serious chronic conditions, the medical implications were very troubling.

Congress crafted the “doughnut hole” to limit federal spending on the drug benefit. Beneficiaries pay only deductibles and co-payments, with the rest covered by their insurance plan, until their drug purchases reach a specified limit. Last year, the gap began when beneficiaries purchased $2,400 worth of drugs. Then they fell into the doughnut hole and had to pay the full cost until their out-of-pocket spending reached $3,850, at which point they qualified for catastrophic coverage.

Last year, an estimated 3.4 million beneficiaries reached the coverage gap, according to a study by researchers at the Kaiser Family Foundation, Georgetown University and the National Opinion Research Center, or NORC, at the University of Chicago. Beneficiaries taking drugs to treat such chronic conditions as Alzheimer’s disease, diabetes, depression, osteoporosis and high blood pressure were especially likely to reach the gap.

What’s disturbing is that 15 percent of the beneficiaries taking drugs in eight categories said they stopped taking their medications when they reached the gap. Another 1 percent reduced their use by skipping doses, and 5 percent switched to another drug that was cheaper but might or might not be as effective.

For the 10 percent of diabetics who stopped taking their medication after reaching the gap, the health consequences could be immediate and serious. For those with high cholesterol or osteoporosis, the harm could take longer to show up but could still be serious.

There is no easy solution short of increasing federal spending or finding a way to drive down the cost of drugs. The program has helped millions of older Americans. The next administration and Congress will have to revisit the wisdom and need for the gap.



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