Alexandria, VA: Spiking drug prices are taking large numbers of Medicare beneficiaries by surprise according to a new survey by The Senior Citizens League (TSCL). Sixty-one percent of people with Medicare drug coverage report higher co-pays and co-insurance costs than expected in 2014 according to more than 1,000 survey participants. The reason for the cost spikes may be tough for many beneficiaries to figure out, according to the survey. Sky-high drug prices are commonly associated with brand and newer specialty drugs, but cost spikes are now affecting generics as well.
Millicent Graves of Williamsburg, Virginia recently was shocked to discover an astounding price range in the same generic drug after her doctor prescribed a different form of Clobetasol propionate, commonly used to treat psoriasis. When she filled her previous prescription in December of 2014 for the Clobetasol solution, she paid $35 — the full retail cost. But when filling the first prescription for Clobetasol foam in 2015, Graves discovered the retail cost was $475.88. And five weeks later when she refilled her prescription for the foam, the cost had jumped dramatically— to $627, making the total difference in price between the solution and foam 1,691%. “When I looked at the receipt I almost passed out,” she says. “Everything is the same as the first bottle! It’s price gouging,” she says.
The foam has been more effective in clearing most of Graves’ symptoms and her Medicare Part D plan has paid for most of the cost of the “golden foam” so far. But Graves is keeping use of the medicine to a minimum, not only for health reasons, but because she doesn’t want to run through her Part D initial coverage limit and hit the doughnut hole.
The Part D initial coverage limit is $2,960 this year. “That includes what both the beneficiary and the drug plan must pay, ” explains TSCL’s Chairman Ed Cates. Once in the doughnut hole, beneficiaries are on the hook for 65% of the cost of generic drugs, or 45% of the cost of brand name drugs. Medicare beneficiaries must spend a total of $4,700 out of pocket in drug costs for the year, before catastrophic coverage kicks in. “Even then there’s still some additional smaller co-insurance payments,” Cates adds.
Clobetasol propionate is one of four medications that accounted for the most significant generic price increases in 2014 according to information on the website of pharmacy benefit manager Express Scripts. The steep climb in generic drugs prompted a Senate hearing last year. The prices of more than 1,200 generic medications increased an average of 448 percent between July 2013 and July 2014, according to Senator Bernie Sanders (I-VT), ranking member of the Senate Subcommittee on Primary Health and Aging.
Graves can’t understand why the pricing is going unchecked by the federal government. “This needs to be investigated,” she says. “People who don’t have good Part D coverage or the money to pay for their drugs would be forced to go without,” she protests. “It’s GREED, GREED, GREED!”
TSCL believes that the extreme cost increases are putting Medicare beneficiaries and funding for Part D at risk. “Medicare must be given the authority to negotiate pharmaceutical prices with manufacturers for covered Part D drugs,” says Cates. How are rising healthcare costs affecting you? TSCL wants to hear from you, visit www.SeniorsLeague.org.
With about 1 million supporters, The Senior Citizens League is one of the nation's largest nonpartisan seniors groups. Located just outside Washington, D.C., 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 TREA The Enlisted Association.
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“The Reality Behind Generic Drug Inflation,” Express Scripts, December 30, 2014, http://lab.express-scripts.com/insights/drug-options/the-reality-behind-generic-drug-inflation.