Medicare Part D plans can make it hard to get prescription drugs

As you might already know, Medicare Part D plans can make it hard to get the prescription drugs you need. That’s not to say you shouldn’t have Part D coverage because it could protect you from out-of-control prescription drug bills. But, you still might spend less paying for your drugs out of pocket with a discount coupon from GoodRx or through Costco mail order or from a verified pharmacy abroad.

First, the good news. Beginning next year, your out-of-pocket costs for drugs that Medicare Part D covers will be capped at $2,000 a year. The Inflation Reduction Act, one of President Biden’s big accomplishments is responsible for that limit as well as negotiated drug prices for some of the highest cost drugs in Medicare.

But, corporate health insurers offering Part D like to make money, so they are finding ways to shift more costs on to their enrollees.Part D insurers are making it hard for their enrollees to fill certain prescriptions. Either these insurers are not covering certain medicines altogether or they are forcing people to go through multiple hoops before they will pay for certain drugs, according to a recent Health Affairs study.

For the most part, if a Part D plan does not cover a drug, then that drug is not subject to the $2,000 out-of-pocket cap.

How do Medicare Part D insurers limit their prescription drug spending and/or boost their revenue?

1. They don’t include certain drugs on their formulary; they now don’t cover 30 percent of drugs, up from 21 percent 13 years ago. Apparently, they are now not covering come drugs that treat cancers and autoimmune disorders.
2. They promote brand-name drugs for which they get large rebates from pharmaceutical manufacturers and make copays for generic substitutes more expensive or simply don’t cover generics.
3. They restrict access to drugs through prior authorization requirements. In 2020, they restricted access to 44 percent of them.
4. They require the use of generics and won’t cover brand-name alternatives.

Why does the government permit these restrictions?

Here’s more from Just Care:

• Online pharmacies can save you money
• Millions safely import low-cost drugs from abroad
• Billions in Medicare savings from Medicare drug price negotiation by 2031
• Case study: Costco saves one couple hundreds of dollars over Medicare Part D
• Medicare names 10 drugs subject to price negotiation