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Medicare Part D drug costs rising

Written by Diane Archer

The private Medicare plan bait and switch continues. It wasn’t that long ago that copays in private plans were reasonable, affordable even, without Medicare supplemental insurance to pick up the cost. This year, Medicare Part D drug plans have moved from fixed copays to coinsurance, a percentage of the cost, for the majority of drugs they cover.  Consequently, out-of-pocket prescription drug costs are projected to rise again for people with Medicare.

The advantage of traditional Medicare, beyond the wide choice of doctors and hospitals it offers anywhere in the country and easy access to care, has always been that it allows people to budget for their health care.  With supplemental insurance, there are few if any out-of-pocket costs. And, while supplemental coverage can be costly, knowing health care costs for the year gives people peace of mind.

But, until Congress allows CMS to negotiate drug prices instead of permitting drug companies to charge astronomical prices, drug costs will continue to escalate for everyone.  For now, Congress has chosen to penalize the public and reward the drug industry since insurers have limited if any ability to rein in drug prices. To keep premiums down, they simply shift more costs to their members.

The share of Medicare Part D drugs with coinsurance payments has been growing steadily in the last few years. According to Avalere Health, 58 percent of covered drugs in Part D plans now have a coinsurance payment. In 2014, about one in three drugs in Part D plans (35 percent) had coinsurance payments. Last year it was 45 percent.

The Medicare Advantage plans are also shifting increasingly to coinsurance payments for certain drugs. This year 26 percent of their drugs have coinsurance payments.  You can expect that to increase.

Here’s more from Just Care on prescription drugs:



  • I used to take a med called Arthrotec for arthritis pain. Then Medicare stopped covering it so my doctor found out the ingredients (diclofenac and misoprostol) and substituted two pills for one forcing me to pay two co-pays. Now my misoprostol alone costs about $30/month (up from $5) plus another $5/month for the diclofenac. I’d leave off the misoprostol but when I do the diclofenac causes severe heartburn. I’ve been told by Medicare to have my doctor claim an exception for the Arthrotec but haven’t found a doctor willing to go through all the paperwork.

  • Follow up on my previous post. I talked to my doctor about negotiating an exception. His comment – “That’s just a way to get you off the phone. I have tried this before and have never had an exception approved. There is way too much paperwork involved and the outcome is always the same.”

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