Shopping For a Better Drug Plan NOW Can Put More Money in Your 2020 Budget
By Mary Johnson, editor
One-out-of-five people who participated in TSCL Senior Survey spend more than $250.00 per month out-of-pocket on prescription drugs. That’s an enormous amount, considering the average Social Security benefit is just $1,460.00 per month. But even if you only take generics, or your Medicare drug or health plan premium goes down, this does not mean that your 2020 Medicare plan’s drug coverage costs will also decrease. Your Medicare drug plan’s prescription coverage – including which drugs are covered by your plan, and the cost, usually changes every year.
Medicare’s Fall Open Enrollment Period started on October 15th and will run through December 7th. For the past 14 years, I have volunteered to help neighbors and friends learn about changes in their current Part D prescription drug or Medicare Advantage coverage during this period. We compare options, track down the lowest costing plans and pharmacies, and often switch to a lower-costing plan when there’s a better deal.
Doing this can be worth hundreds, if not thousands, of dollars in savings in a single year, and it’s surprisingly simple. Free one-on-one counseling is available from local Medicare benefits counselors like me in every area of the country, through State Health Insurance Programs (SHIP). Many of these programs operate through local area agencies on aging, senior centers, and community health centers.
Here are a few secrets about Part D coverage that keep you stuck in your plan and overpaying for prescriptions:
- Most people don’t know where to begin, and the process is designed to overwhelm you before you start. You, however, do not have to be one of these people. All you need to do is to call and set up a free counseling session with a local Medicare benefits counselor. Do this NOW. Locate the program in your area on the State Health Insurance Program website — https://www.shiptacenter.org.
- Because Medicare doesn’t negotiate drug prices, there are huge variations in cost for the same drug between drug plans, and even between pharmacies in the same plan. The difference in drug prices between the lowest and highest costing plans and pharmacies can be in the hundreds, or even thousands, of dollars. The high cost of drugs are the single biggest reason that people don’t fill a prescription! But the most frequent reason that a drug costs so much more in the highest costing plan is lack of coverage by the drug plan —the drug is not listed on the plan’s formulary. Sometimes, the pharmacy is not in the plan’s preferred “network”, and even preferred pharmacies can have significantly higher costs. 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 formulary. The lowest cost plan for Advair Diskus, which is used to control and prevent symptoms of pulmonary disease, charges a co-pay of $38.33 per month from a mail order pharmacy, or the highest cost plan charges $626.62 per month because the drug is not on the plan’s formulary.
- High drug or health plan premiums don’t necessarily purchase better coverage. For example, the generic blood pressure medication Lisinopril is one of the most commonly used prescriptions by Medicare beneficiaries. The least expensive Part D plan in my area charges $0 copay for Tier 1 generics, and the monthly premium is just $14.50 in the zip code used in this search. The most expensive plan charges a co-pay of $9.19, and the plan has a monthly premium of $93.30 — a difference of $1,055.88 for the entire year counting premiums!
- Surprise! A new Part D plan drug pricing program 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 on certain drugs. A new drug plan pricing program offered by Cigna, for example, lowers the cost of insulin. In 2018, the lowest cost Part D plan charged an $80 copay for a 100/ML of Lantus Solostar. In 2019, the lowest cost plan in my area charges copays as low 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. Which would you rather have?
It pays to compare your options, but you need to do this soon, before the Medicare Open Enrollment period ends December 7th. For help shopping for a new drug or health plan locate Medicare benefit counselors in your area. Visit the State Health Insurance Program website — https://www.shiptacenter.org.
