October 24, 2019
Part D Cost for Brand Name Drugs Rising
Reforms to Medicare Part D under the Affordable Care Act brought significant relief to retirees by reducing the share of medication costs they must pay out of their own pockets.
But with the healthcare reform now nearly a decade old, other developments have taken over that will drive up drug costs for the most vulnerable retirees – the biggest users of expensive brand name drugs. Although only a few million people will be affected, they are already saddled with the highest spending burden.
This vulnerable group could get some help from Congress. There is bipartisan support for placing an absolute limit on how much Part D policyholders must pay in total for their prescriptions, said Juliette Cubanski, associate director of the Medicare policy program at the Kaiser Family Foundation.
“That’s a positive development,” she said, “but there are also several areas of disagreement in the legislation being considered on the House and Senate sides.”
Under the Affordable Care Act (ACA), retirees are required to pay 25 percent of their total drug costs up to the annual threshold that qualifies them for catastrophic coverage – this dollar threshold is the total of their own payments plus the price discounts from manufacturers of brand name drugs. The upshot in 2020 for retirees is that those with the highest need could spend about $375 more out of their own pockets before they enter Part D’s less-onerous catastrophic coverage phase, according to a Kaiser analysis. And that’s just the increase for next year – their outlays will rise over the next decade.
Once retirees enter the catastrophic phase, they are protected, because Medicare begins picking up the vast majority of the tab. But out-of-pocket costs are rising because the ACA’s controls on the spending threshold they must cross to qualify for catastrophic coverage have ended. …Learn More
March 19, 2019
Boomers Cope with Real Financial Pain
We really appreciate readers opening up about their personal experiences in the comments section at the end of each blog. It’s important to stop occasionally and listen to what they have to say.
Aging readers reacted strongly to blog posts in recent weeks about two of the biggest challenges they face: spiraling prescription drug costs and a so-so job market for older workers who aren’t ready to retire.
Here are summaries of their comments on each article:
High Drug Prices Erode Part D Coverage
Readers expressed anger about rising prescription drug prices in response to a blog featuring a diabetic in Arizona who, despite having a Medicare Part D plan, spends thousands of dollars a year for her insulin. She resorts occasionally to buying surplus supplies on eBay from private individuals.
Dr. Edward Hoffer in Boston responded that Americans pay five times more for Lantus than diabetics in the rest of the world. “The same is true for most brand name drugs and most medical devices. It is an embarrassment that we pay double per capita what comparable western countries pay for health care with worse national health statistics,” he said.
Bill MacDonald shared his story in a Tweet and follow-up messages. This North Carolina retiree on a fixed income has paid $6,000 annually out-of-pocket – a third of his income – for two drugs he’s taken since an automobile accident caused medical problems and depression that led to other issues. He spends $3,200 for one of the drugs, a cholesterol medication called Repatha – that’s his tab after his insurance company pays for most of it. (Last year, Amgen slashed Repatha’s price from more than $10,000 per year to $5,850, which MacDonald hopes will reduce this expense.)
Steve B. was thrilled about a new generic on the market to replace his Rapaflo, a prostate medication. Then he learned that the generic is not much of a bargain either.
Careers Become Dicey after Age 50 …Learn More