Majority of Drugs Now Subject to Coinsurance in Medicare Part D Plans

[eridani]

http://avalere.com/expertise/managed-care/insights/majority-of-drugs-now-subject-to-coinsurance-in-medicare-part-d-plans

A new analysis from Avalere finds that a majority of prescription drugs covered by standalone Medicare Part D plans (PDPs) are subject to coinsurance, rather than copayments, in 2016. Coinsurance is when a beneficiary pays a percentage of the cost of the drug, rather than a fixed dollar amount, or copayment. Coinsurance often leads to patients paying more out of pocket compared to fixed dollar amount copayments. The average percentage of covered drugs facing coinsurance has risen sharply from 35 percent in 2014 to 58 percent in 2016 among PDPs. While most PDPs have historically applied coinsurance to high-cost drugs on the specialty tier, plans have extended coinsurance to drugs on lower tiers in recent years, including those covered on preferred and non-preferred brand tiers.

“These very high rates of coinsurance have shifted our understanding of Part D formulary coverage,” said Caroline Pearson, senior vice president at Avalere. “It will be important to monitor what drugs are being placed on various coinsurance tiers and how plans are using these tiers to manage cost and utilization in the program.”

Comment by Don McCanne of PNHP: Medicare Part D drug plans are shifting more drugs from a copayment requirement - a fixed dollar amount to be paid for each prescription - to coinsurance - a percentage of the charge for each prescription. This is important because coinsurance payments tend to be higher than coinsurance - sometimes much higher - especially with the recent increases in drug prices.

Obviously this is simply one more method of shifting the costs of health care to the patient. Many are already finding out-of-pocket costs to be unaffordable, yet it keeps getting worse. This is a one way street. The insurers are not looking for ways to reduce out-of-pocket expenses since they would have to pick up the additional costs which would then make their premiums less affordable, and the last thing that they would want to do is risk losing market share through higher premiums.

Coinsurance is a method of reducing health spending by erecting financial barriers to the care that patients should have. Instead, we should be removing financial barriers to care. That is what an improved Medicare for all with first dollar coverage would do.

[nichomachus]

1. Oh, don't worry about Part D. We know it's not perfect

Don't let the perfect be the enemy of the good. This is a first step and it's better than nothing. Pass this, and we can fix it later.

That's the line of horse shit we were fed in 2003 and it's the same line of horse shit we get every time they're trying to scam us.

Nothing has been done jn 13 years to fix Part D, which is just a giveaway to the drug and insurance companies.

Any time you hear that line of horse shit, know that you are being had.

[Baobab]

2. Medicare Pard D has been a 16 TRILLION dollar mistake

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/downloads/tr2011.pdf

[Nye Bevan]

3. Isn't it optional?

If it's so awful, why have so many chosen to sign up for it?

[Wounded Bear]

5. Because for people in their 60's and up...

there aren't a lot of options, at least any that are affordable for someone on a fixed income, like retirees.

[dixiegrrrrl]

8. Dunno for sure, but I think people have been scared into getting insurance.

I have an 89 y/o neighbor who has good insurance.
We often go the pharmacy together, as she worries about driving.
She pays more for her insured meds than I pay for uninsured meds...same meds.
Her insurance covers the brand name, I buy the much cheaper generic.

but, she will not change anything, so I have given up talking about it.

[nichomachus]

9. Because then you have to pay outrageous inflated prices for drugs

Drugs I can buy in Mexico for $25 cost $300 and up in the US. Same drug. Same manufacturer.

I was in Spain two years ago and needed an antibiotic. Because I wasn't on their national health care, it cost me 20 euros. The exact same drug in the US is $185.

[passiveporcupine]

10. I refused to sign up for it for two reasons

One was that when it was started, they could not give me any info on what the copay would be on the drugs I used. Second, I was pissed that they did not set it up so they could negotiate pricing, and not knowing what my copay would be, and knowing the prices to start with for many drugs were just ridiculous and beyond my reach (like $300 or so for a Pulmicort inhaler), I just couldn't justify it.

So now it's been so long since I didn't sign up, that prices have risen so much on drugs that I probably should have it, but there is a 10% penalty for every year you didn't sign up and that was a long time ago, and now the premium alone would be over $100 a month for me. I can't afford that on top of deductible (I don't know if there is a deductible) and copays.

But with this latest change in coverage, I guess it was a good thing I didn't sign up for it, because paying 58% of the drugs, plus the premium, would still put me out of the ball park.

[SheilaT]

13. If you don't sign up when first eligible,

there's something like a 10% penalty for each year, or maybe each month you delay.

So even if you are not taking any prescription meds, it's a very good idea to sign up for Part D.

I'm in an Advantage plan, no additional cost to me beyond the $104.90/month Medicare takes. The three generic drugs I take are completely covered -- I get a 90 supply mailed to me no copay, no shipping charge. The Advantage plan also has zero copay for routine doctor visit, and various other benefits.

I still don't fully understand why more people don't do an Advantage plan, but then a lot depends on where you live as to what's available.

[Skwmom]

4. Considering the Democrats had the Whitehouse, the Senate, AND the house and did not take

care of this speaks volumes.

[Else You Are Mad]

6. How about this?

We spend tax dollars to ensure that people don't die. We spend so much on war and death and we never ask how much that costs. Yet, we in a day and age where we can save lives, we squabble about if we should save lives or how much it would cost. No one should die because they can't afford medical treatment or because the medical treatment isn't approved by a company looking to make money. Life is sacred & I would prefer my tax dollars to go to save a person suffering than to make sure we bomb the right country to get their oil. Call me old fashioned, but I choose life.

[passiveporcupine]

7. I'm on Medicare but I don't have part D, so no prescription help

I went in last week to pick up a few prescriptions and when they totaled my bill it came up to $350 and my eyes popped out. I asked them what this one item was that was $150...and it was one of my pills (a three month supply). I asked why it was so high, because the last time I bought it, it was only $37. It is a generic medication that a lot of people use, and somebody just quadrupled the price. Needless to say, I was pretty upset.

I had to refuse it. I didn't have enough to pay for it.. I had to call my doc this week to write me a prescription for something I can afford. There was something available, but what if there wasn't?

The cost of health care and meds has been out of sight for too long, but meds seem to be rising even faster lately.

We really need Bernie in the White house.

[Marbgd1]

11. :candle:

Best of luck to you.

Yes, we do.

Semper Fi

[passiveporcupine]

12. Thanks

I'm just lucky I don't need one of those drugs that cost thousands a year. I don't know how some people do it.

[FairWinds]

14. Ya know people, when thievery like this happens . .

in actual democracies, people hit the streets by the hundreds of
thousands and millions when shit like this happens.

The only reason it happens here is that we (OK, you) put up with it.

How can the people of Arizona be so passive as their voting rights are absolutely trashed?

Land of the brave? I don't think so !!