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Tag: Medicare Part D

  • Which outpatient drugs are costing Medicare the most?

    Which outpatient drugs are costing Medicare the most?

    In a little more than a month, we will know which ten outpatient prescription drugs will be subject to Medicare price negotiation under the Inflation Reduction Act in 2025. (That’s if the pharmaceutical companies do not prevail in their lawsuits aimed at stopping Medicare drug price negotiation.) The drugs whose prices will be negotiated will be those, covered under Medicare Part D, that are costing Medicare the most.

    In 2026, Medicare will negotiate prices for 10 additional drugs. In 2027, Medicare will negotiate prices for 15 additional Part D drugs. In 2028, Medicare will negotiate prices for yet another 15 Part D drugs.

    Beginning in 2029, Medicare will negotiate prices for 20 drugs covered under Part D and Part B, which covers inpatient drugs. Under the law, Medicare can only negotiate the prices of single-source brand-name drugs, which have been on the market for at least seven years, or biologics that do not have biosimilar options, which have been on the market for at least 11 years.

    A small number of drugs are responsible for a significant portion of Part D prescription drug spending. Medicare spent $48 billion on the ten drugs with the highest spending in 2021. Half of those drugs are treatments for diabetes: Trulicity, Januvia, Jardiance, Lantus Solostar, and Ozempic. The other half include Imbruvica, a cancer treatment and Humira Citrate-free (Cf) pen, a treatment for rheumatoid arthritis.

    Prescription drug prices are soaring, especially for the drugs that Medicare is spending the most on. In the three years between 2018 and 2021, the price of these ten drugs more than doubled. Spending jumped from $22 billion to $48 billion. Total Medicare Part D spending rose from $166 billion to $216 billion.

    Twenty-two percent of Medicare Part D spending results from just ten drugs out of a total of 3,500 (0.3 percent) that Medicare covers under Part D. Sixty-one percent of total spending results from just 100 drugs (3 percent of covered drugs).

    In 2021, Medicare spent $2.6 billion on Ozempic, to treat diabetes for 500,000 Medicare patients, $5 billion on Revlimid, to treat multiple myeloma, and $12.6 billion on Eliquis, a blood thinner.

    Not all of these drugs will be eligible for drug price negotiation: Ozempic, Revlimid, Humira and Lantus are not eligible. Ozempic has not been on the market long enough and the other three have biosimilars.

    The Congressional Budget Office estimates that, as a result of drug price negotiation, Medicare will save $100 billion on prescription drugs costs in the five years beginning in 2026. That’s a beginning, but hardly enough. If Congress would only permit prescription drug importation from verified pharmacies abroad, it would help drive down drug prices considerably.

    Here’s more from Just Care:

  • Biden administration penalizes drug companies hiking drug prices above the rate of inflation

    Biden administration penalizes drug companies hiking drug prices above the rate of inflation

    The Inflation Reduction Act (IRA), which became law in August 2022, appears to be working to rein in the ever-escalating price of some prescription drugs. Jonathan Cohn writes for the Huffington Post about 43 prescription drugs with price increases greater than the rate of inflation. The Biden administration has signaled them out for Medicare savings, imposing penalties on the drug companies that manufacture them.

    Humira, a very popular drug that treats inflammatory conditions, and Leukine, a drug that protects people on chemotherapy from infections, are two drugs with big price hikes that the Biden administration has identified. As a result of the IRA, our federal government will impose monetary penalties on drug companies manufacturing  the 43 drugs with excessive price increases. And, people with Medicare who take any of these drugs will pay lower coinsurance for them, saving $1 to $449 per prescription.

    None of the drugs on this initial list are prescription drugs covered under Medicare Part D. Rather they are all administered by a doctor and are covered under Medicare Part B, under which people pay 20 percent coinsurance if they do not have supplemental coverage to pick up that cost. People with supplemental coverage should also benefit from the IRA because the government penalties should help keep their supplemental insurance premiums down.

    Over time, the list will grow to the extent pharmaceutical companies raise prices at rates greater than the rate of inflation. And, the list will include drugs covered under Medicare Part D.

    The IRA also caps insulin costs for people with Medicare to $35 a month. And, beginning in 2025, the IRA caps out-of-pocket spending under Medicare Part D at $2,000 a year.

    All these advances to curb prescription drug costs for the Medicare program and the older adults and people with disabilities who count on Medicare are meaningful. These reforms will make it much easier for many people to get their drugs. But, the IRA still leaves people with Medicare paying far more than people in other wealthy countries for their drugs. And, even with the IRA, pharmaceutical companies can gouge Americans when it comes to drug prices.

    Here’s more from Just Care:

  • Don’t rely on Mark Cuban’s Cost Plus Drugs for the lowest prices

    Don’t rely on Mark Cuban’s Cost Plus Drugs for the lowest prices

    I promoted Mark Cuban’s Cost Plus Drugs a while back as a way to get low-cost generics. As it turns out, Darius Tahir reports for Kaiser Health News that Cost Plus Drugs does not always offer the lowest prices. Bottom line, if you have Medicare Part D, you should shop around if you want the lowest prices on your drugs.

    Cost Plus Drugs now offers more than 1,000 prescription drugs. But, it does not manufacture them. So, your local pharmacy could offer the drugs you need at lower prices. You can also check PharmacyChecker.com for low-cost drugs around the world.

    Cost Plus Pharmacy negotiates prices. And, then it is charging you a 15 percent markup from the manufacturer’s price, plus $3.00 for labor for each medicine and then a flat $5 fee to ship as many drugs as you order.

    In a cost comparison of drugs beginning with the letter A, Kaiser Health News (KHN) found Cost Plus Pharmacy did not offer the lowest drug prices for residents of Washington DC most of the time. But, sometimes it offered massive savings. One expensive drug, aprepitant, an anti-nausea medicine, was nearly $1,000 less through Cost Plus Drugs than through GoodRx, $4,815.30 v. $5,740.

    Cost Plus Drugs is really taking out a lot of the PBM (Pharmacy Benefit Manager) and pharmacy markups, since it replaces the PBM as the middleman. Amazon and Walmart are also offering a bunch of low-cost generic drugs.

    Cost Plus Drugs is not a pharmacy but uses Truepill, a mail-order pharmacy.

    Bottom line, you Part D drug coverage should offer you some savings on some drugs, particularly brand-name drugs. But, don’t count on it to give you the lowest out-of-pocket costs. The copays can be higher than the total cost of your drugs through Costco or Cost Plus Drugs, at least for now.

    The good news, if you take a lot of drugs, is that beginning in 2026, you will not pay more than $2,000 in total for your prescription drugs on formulary through your Part D drug plan. That is one of the big benefits of the Inflation Reduction Act passed in 2022.

    Here’s more from Just Care:

  • Case study: Costco saves one couple hundreds of dollars over Medicare Part D

    Case study: Costco saves one couple hundreds of dollars over Medicare Part D

    If you ask me, often the smartest way to save money on prescription drugs is to import them from abroad. But, though no one has ever reported a safety issue from importing drugs from verified pharmacies abroad, importation is still not legal, even for personal use. One Just Care reader, D Busa, wrote in to explain how he saves money on prescription drugs without relying on importation and, with his permission, I am sharing Busa’s story.

    Busa takes a good bit of time to check out all his options under Medicare Part D, which provides prescription drug coverage, each year. Most people with Medicare don’t take that time, even though it’s super important. Whether you’re in Traditional Medicare or in a Medicare Advantage plan, the Part D plan or Medicare Advantage plan offering Part D coverage that met your needs one year, can cost you a lot more than expected the following year.

    Unfortunately, with Part D, your prescription drug costs can change at any time. And, if you need new drugs, the plan you chose because of its lower cost for the drugs you had been taking could end up costing you more than other Part D plans because of new drugs your doctor prescribes. Curiously, even when you are a careful shopper of Part D plans, you can sometimes save a lot of money getting your drugs without relying on Part D coverage.The system is INSANE. It works very well for the insurers at the expense of people with Medicare.

    Busa saw his prescription drug costs rising in Medicare Part D even though he shopped around for the best possible Part D plan. So, he looked to see whether he could get the single prescription drug he takes for less without using his Part D coverage. He found that by using Costco mail order, he could reduce his annual out-of-pocket costs by $459,  $275 through Part D premium savings and $244 for drugs through Costco minus the $60 for annual Costco membership.

    Again, the only word to describe Busa’s discovery that his Medicare Part D plan was effectively ripping him and Medicare off is INSANITY. How in god’s name does Medicare agree to pay its share of the cost of a Part D drug or say it is providing Medicare coverage for a drug that costs so much less at Costco without prescription drug coverage?

    Busa found that his wife was also better off getting two of her drugs through Costco. On Part D, she paid $280 for the drugs. At Costco, she paid $57, saving $223 over three months.

    Busa explains that sometimes Part D is less expensive than Costco. Two other drugs his wife takes cost her $6 through her Part D plan and $14 at Costco.

    Busa’s strategy is to pick the Part D plan with the lowest premium. By doing so, he says, “overall I save $550 on Part D premiums and $1,684 on drugs or $2,234 annually.” INSANITY.

    Here’s more from Just Care:

  • 2023: Medicare Part D prescription drug coverage and costs

    2023: Medicare Part D prescription drug coverage and costs

    Whether you are enrolled in traditional Medicare or a Medicare Advantage plan, Medicare covers the prescription drugs you get from the pharmacy under Medicare Part D. The vast majority of people with Medicare, 49 million in 2022, are enrolled in a Part D drug plan. Here’s what you need to know about Medicare Part D coverage and costs in 2023.

    Don’t assume that your current Part D drug plan will cover your drugs in 2023, even if they did in 2022. Rather, assume that your costs will go up a lot if you didn’t check which Part D plan was likely to save you the most money based on your drug needs, during the Medicare open enrollment period (October 15-December 7). Each year, these private insurance plans can change dramatically. Kaiser Family Foundation reports on your options.

    As a general rule, close to three in four people enrolled in traditional Medicare and a Part D plan will pay higher costs the following year, if they do not look at their options and switch plans.

    In 2023, there are 16 national Part D prescription drug plans, with monthly premiums ranging from $6 to $111. The average premium is $43, up 10 percent from 2022. AARP offers the highest cost Part D drug plan.

    Premiums: Premiums are typically higher for Part D plans offering enhanced benefits, lower cost-sharing and/or low or no deductibles. Standard Part D plans have an average monthly premium of $37. Part D “enhanced” plans that charge no or a low deductible have an average monthly premium of $48 in 2023.

    Standard deductible: The standard and highest possible deductible—the amount you must pay before your coverage begins—is $505.

    If you have traditional Medicare: You typically will be able to choose among 24 Part D drug plans. Depending upon the state you live in, your options range between 19 and 28.

    If you are in a Medicare Advantage plan: You typically will have a choice  of around 35 Part D drug plans.

    Cost-sharing: For non-preferred brand name drugs, coinsurance could be as high as 40-50 percent and as low as $0 for preferred generics, depending upon the Part D plan you choose. You also are likely to pay 15-25 percent coinsurance for preferred brand drugs.

    Typically you’ll pay about $1 for preferred generics and $5 for generics. You’ll pay around $44 copay for preferred brands, 45 percent coinsurance for non-preferred drugs, and 25 percent coinsurance for specialty drugs.

    Costs in each coverage phase: After you have paid your deductible, you are in the initial coverage phase, where you generally will pay around 25 percent of the cost of both brand-name and generic drugs until your drug costs total $4,660. You will then be in the coverage gap phase, where you will be responsible for about 25 percent of the cost of your drugs. Once your out-of-pocket drug costs total  $7,400 in the coverage gap phase, you will be in the catastrophic coverage phase . At that point, you will pay no more than 5 percent of the cost of your drugs or $4.15 for each generic and $10.35 for each brand-name drug.

    If you qualify for a low-income subsidy (LIS) or Extra Help: You will have lower out-of-pocket costs, depending upon the Part D plan you choose and the drugs you use. Around 13 million people with Medicare qualify for extra help with their prescription drug costs. There are 198 Part D drug plans for which you will not pay a premium. You can also choose a “non-benchmark” plan and pay a portion of the monthly premium.

    If you need insulin: The Inflation Reduction Act limits your monthly copayment to no more than $35 in all phases of Part D coverage. However, that limit applies only to insulin in a plan’s formulary, not all insulin products.

    If you need a vaccine: Vaccine costs are covered in full for vaccines that are on the Part D formulary.

    Here’s more from Just Care:

  • Drug provisions in the reconciliation bill should lower your costs

    Drug provisions in the reconciliation bill should lower your costs

    Last week, I laid out the Medicare prescription drug provisions in the reconciliation bill. They are noteworthy. Among other benefits, for the first time, people with Medicare Part D prescription drug coverage will spend no more than $2,000 out of pocket for their drugs, and Medicare will be allowed to negotiate the price of 100 prescription drugs through 2030. If you’re taking costly medicines, these provisions should lower your drug costs significantly.

    Beginning in 2023, Medicare drug prices cannot rise faster than inflation. If they do, the manufacturer must pay a rebate to the federal government. So, you should no longer see your Part D prescription drug costs rise more than the rate of inflation. The base year for measuring cumulative price changes is 2021.

    In 2024:

    • if you reach the catastrophic coverage phase of your Part D coverage, meaning that you have spent $7,050 out of pocket for covered drugs, you will no longer have to pay five percent of the cost of your drugs. You will have no drug copay.
    • if your income is under 150 percent of the federal poverty level, you will be eligible for full Extra Help benefits, which cover your Part D out-of-pocket costs.
    • your Part D premium cannot increase more than six percent a year.

    In 2025, your maximum out-of-pocket Part D drug costs will drop to $2,000 a year.

    In 2026, Medicare will begin negotiating drug prices for 10 Part D brand-name drugs. The law is silent as to the drugs for which Medicare will negotiate prices, other than that they must be high-cost and have been on the market for at least nine years since FDA approval. The Secretary of Health and Human Services will choose the drugs for which prices will be negotiated.

    In 2027, Medicare will negotiate drug price for 15 Part D drugs.

    In 2028, Medicare will negotiate another 15 drugs in Medicare Part D and Part B.

    In 2029, Medicare will negotiate the price of 20 drugs.

    It’s not clear when we will know which drugs will have negotiated prices or how these prices will affect people who take these drugs. Even today, each Medicare Part D drug plan might charge you a different amount out of pocket for a particular drug, depending upon a variety of factors.

    Steve Maas points out in the Washington Post, that a blood pressure medicine, lisinopril, could cost you nothing or as much as $29 at the same pharmacy with Part D. Without insurance, it costs $4 at Walmart. Maas takes a basket of drugs and reveals that, overall, at least for the five drugs he chooses, you will save a lot of money using the pharmacy at your local Giant supermarket over going to CVS, $11 v. $46.55.

    How will the Secretary of HHS arrive at the negotiated price? We don’t know yet whether the Secretary will be able to achieve the deep discounts that other wealthy countries are able to negotiate or a much smaller discount. But, most likely the latter, given politics in the US. And, then there’s the question of how much of the discounts the Part D plans will pass along to their members in terms of out-of-pocket costs.

    There is a price ceiling for drugs whose prices are negotiated, which depends upon how long the brand-name drug has been on the market. The lowest ceiling is 40 percent of the drug’s fair price (which there’s a formula for calculating), for drugs that have been on the market for at least 16 years. The highest ceiling is 75 percent for drugs on the market between nine and 12 years.

    There is a penalty on manufacturers for non-compliance. Manufacturers must pay an excise tax of 65 percent of the prior year’s sales of that drug, which increases by 10 percent every quarter up to 95 percent. And, if the drug has a negotiated price that the manufacturer opts not to charge, the manufacturer could pay a penalty of as much as 10 times the difference between the price it charges and the negotiated price.

    What does this all mean for the Medicare Part D plans? If there’s any way they can avoid including the negotiated drugs on their pharmacies, they might try to do so, because they might not profit as much from them. We know that CVS excludes some generics from its formularies, forcing enrollees to pay more for their brand-name equivalents, surely because CVS maximizes profits in that fashion.

    Part D prescription drug plans have way too much freedom to take advantage of the system and drive up costs for their enrollees. Enrollees are at an enormous disadvantage because drug tiers and coverage can change at almost any time. People truly cannot choose the Part D plan that’s right for them.

    Unfortunately, Congress does not have the authority to include drug price negotiation for working people in the reconciliation bill. It can only include provisions that affect the federal budget directly. As a result, millions of Americans will continue to import drugs from abroad for personal use. While it is not technically legal, to date, the government has never prosecuted anyone for doing so.

    Here’s more from Just Care:

     

  • Reconciliation bill would reduce Medicare drug costs

    Reconciliation bill would reduce Medicare drug costs

    The Democrats in Congress appear to be on the cusp of passing a more robust reconciliation package than recently anticipated, now that Senator Joe Manchin is on board. The package should reduce Medicare drug costs, saving money for people with Medicare as well as lives. Among other things, it would cap out-of-pocket expenses for drugs under Medicare Part D at $2,000 a calendar year.

    The reconciliation package includes three key provisions, a $2,000 cap on Part D out-of-pocket costs, which would begin in 2025; Medicare drug price negotiation for a small group of high volume brand-name drugs, which would begin in 2026; and a limit on the amount Pharma can raise prices on drugs to inflation, which would begin in 2023.

    The out-of-pocket cap on Part D should increase access to costly drugs, such as chemotherapies, for a lot of older adults and people with disabilities who have been forced to forgo them as a result of their enormous costs.  Today, 1.45 million people reach the catastrophic coverage cap in Part D. They are then still liable for 5 percent of the cost of their drugs, which can easily be $5,000 or more given that many chemotherapies and other drugs for complex conditions cost well over $100,000. As a result, many stop taking life-saving drugs and die needlessly.

    The limit on drug price inflation helps give the bill teeth. Without this limit, the out-of-pocket cap would make it easier for drug companies to raise prices because, with an out-of-pocket cap, people with Medicare are less likely to notice drug price increases. Yet, if Pharma could raise prices significantly, insurers would be forced to raise premiums, deductibles and copays for everyone with Part D. 

    Unlike most Congressional legislation, the reconciliation package comes with a clear penalty on drug companies that raise their prices above the inflationary rate.  They must provide refunds to people with Medicare for the difference between what they are allowed to charge and what they charge above that amount. 

    The package limits drug price negotiation to ten high-cost drugs each year. HHS will identify those high-cost drugs that have been on the market for at least nine years and have no generic substitute. Beginning in 2029, it allows HHS to negotiate the price of 20 high-cost drugs a year. 

    The package originally had a provision limiting the cost of insulin, which was taken out when Senators Jeanne Shaheen and Susan Collins thought they had a bipartisan majority to support their insulin legislation. Now that these Senators have failed to secure that majority, insulin price negotiation could be included in the reconciliation package. People with Medicare Part D already benefit from a $35 monthly cap on their insulin costs if they choose a Medicare Part D plan with this protection. 

    The package would include free vaccines for about 4.1 million people with Medicare.  

    As of now, we do not know how Senator Kyrsten Sinema will vote on the package or, for that matter, the Democrats in the House of Representatives. That said, a vote on the package is expected shortly.

    Here’s more from Just Care:

  • Does Medicare Part D save you money on generic drugs?

    Does Medicare Part D save you money on generic drugs?

    A new Avalere analysis reveals that more than half of people with Medicare Part D paid the full cost of their generic drugs at least one time in 2020, in some cases as much as they would pay for brand-name drugs. Sarai Radriguez reports for Health Payer Intelligence on the increasing number of people with Medicare Part D who pay the full cost of their generic drugs.

    In the three years between 2017 and 2020, the percent of people with Medicare getting no help from their Part D prescription drug coverage to pay for their generic drugs in at least one instance rose from 45 percent to 63 percent. Their copays were in the same tier as brand-name drugs.

    Drugs for which people paid the full cost included drugs to treat thyroid issues as well as musculoskeletal, cardiotonic, thyroid issues and anxiety. Curiously, a higher percentage of people in low-income subsidy benchmark plans (Extra Help plans) (68 percent) paid the full price of their generics than people in non-benchmark plans (62 percent).

    Medicare Part D plans cannot charge their enrollees more for copays than their negotiated price for a drug. But, they can put generic drugs on high copay tiers, while getting higher discounts for brand-name drugs. So, that’s what they are doing increasingly to maximize their profits. As a result, some brand-name drugs cost enrollees less out of pocket than their generic substitutes during the catastrophic coverage phase of the Part D benefit, even though they cost Medicare more.

    If the skinny version of Build Back Better passes–the reconciliation bill–it would allow federal drug price negotiation for some brand-name drugs without generic substitutes. But, it does nothing to ensure that Part D prescription drug insurers are offering their enrollees coverage at the lowest price possible, for example, at the prices you can get through Mark Cuban’s Cost Plus Pharmacy.

    Here’s more from Just Care:

  • Whistleblower says CVS won’t cover some low-cost generics

    Whistleblower says CVS won’t cover some low-cost generics

    Ed Silverman reports for Stat News on a whistleblower lawsuit against CVS. The lawsuit alleges that CVS won’t cover some low-cost generics, driving up costs for people in the CVS SilverScript Medicare Part D prescription drug plan, while boosting CVS profits. It sounds like CVS is engaged in a big bait and switch with its Medicare enrollees.

    We don’t have the numbers, but many people throughout the US in the CVS SilverScript Medicare Part D plan complain about being forced to buy a higher-cost brand-name drug rather than the generic drug equivalent if they want CVS to cover their medication. CVS kept at least twelve popular low-cost generics off its formulary. The generic drugs treat a multitude of conditions, including high eye blood pressure, dementia, ulcerative colitis and hepatitis C.

    For example, a Part D SilverScript drug plan did not cover a generic form of Advair, an asthma medicine, on its formulary. Instead, CVS required people to buy the brand-name medicine at a much higher cost.

    CVS is charged with keeping its Medicare Part D enrollees from getting generic drugs in order to profit more from covering brand-name drugs beginning in 2015. You would expect CVS to do everything in its power to maximize profits. So, why doesn’t the Centers for Medicare and Medicaid Services (CMS) require all Medicare Part D plans to cover all generic alternatives to any brand-name drug they cover? Moreover, why doesn’t CMS require Part D plans to cover drugs their enrollees secure through Mark Cuban’s Cost Plus Pharmacy and other outlets, when they offer the lowest price for generic drugs?

    CVS can profit more from covering brand-name drugs because their manufacturers send CVS rebates for including their brand-name drugs on its formulary. CVS could redistribute these rebates to its enrollees through lower premiums and copays. But, it can also keep the rebate money for itself. I’ll leave it to you to guess what it does.

    Because CVS owns retail pharmacies, a Part D prescription drug insurance plan, and a Pharmacy Benefit Manager, CVS has myriad ways to boost profits. For this reason, back in 2012, it agreed to maintain a firewall between its different businesses to keep it from engaging in activities that could undermine competition. The lawsuit claims it broke that commitment.

    The lawsuit further claims that CVS developed formularies with fewer generic drugs for patients in Medicare’s Extra Help program, for whom the federal government pays most or all of the copays. These people would be less likely to notice that they were forced to get a brand-name drug, since getting a brand-name drug would have little effect on their copays.

    At the same time that CVS did not offer generic substitutes on its formulary, it also allegedly kept these drugs from being stocked in its pharmacies. What better way to ensure people bought brand-name drugs and not their generic drug equivalents?

    SilverScript is also charged with not making enrollees aware of higher costs associated with brand-name drugs or with using their Part D drug coverage rather than paying cash for drugs.

    Here’s more from Just Care:

  • Medicare Part D insurers unwilling to bring down generic drug costs

    Medicare Part D insurers unwilling to bring down generic drug costs

    A new study published in the Annals of Internal Medicine shows that the Medicare Part D insurers would have saved Medicare several billion dollars on generic drugs in 2020 if they paid Mark Cuban’s Cost Plus pharmacy prices. But, had they done so, these insurers would have lost billions in profits. Why is the administration continuing to promote a failed corporate health insurance model, over public health insurance, to the detriment of taxpayers and people with Medicare?

    The whole idea behind having private health insurers “compete” to offer drug coverage is that competition will bring drug prices down. But, the Part D health insurers are not in business to bring down drug prices. They are unwilling to do what Mark Cuban is doing to bring costs down or even to offer their enrollees coverage of their generic drugs through Cuban’s Cost Plus Pharmacy.

    Ed Silverman reports for Stat News that the study finds $3.6 billion in savings to Medicare in one year alone. Of course, that would mean savings to people with Medicare who use these drugs, as well, in the form of lower copays. When the study was done, Cuban’s company produced 100 generic drugs. Now, it produces 700 drugs, suggesting savings would be far greater now.

    The study’s authors say that “The lower prices from [Cuban’s] direct-to-consumer model highlight inefficiencies in the existing generic pharmaceutical distribution and reimbursement system.” What’s more shocking is that it highlights that the Part D private health insurance model for providing drug coverage to people with Medicare will never put taxpayer interests or the interests of people with Medicare first. (Recently, Kaiser Health News exposed that people can’t even count on a given published price of a drug on the Medicare Part D web site. Drug prices can change at any time at the insurers’ whim.)

    The authors say that 64 cents of every dollar spent on generic drugs goes to the producers and distributors, including pharmacy dispensing and shipping. How much of the price goes to the health insurers?

    Meanwhile, many older adults and people with disabilities are cutting their pills in half, delaying filling their prescriptions or dropping their medications altogether because they can’t afford the cost. For thousands each year, an additional $10.40 in copays means stopping filling prescriptions and premature death, according to a recent NBER study.

    For this study, the researchers looked at 77 generic drugs and found that if the insurers had paid Mark Cuban’s Cost Plus prices, they would have cut 37 percent of Medicare’s $9.6 billion in generic drug costs. An additional 12 generic drugs cost the same with Cuban’s pharmacy as Medicare paid.

    Some of the price differences between what the insurers are paying and what Cuban charges are inexplicably huge. Esomeprazole, which is used to treat acid reflux (a generic for Nexium,) cost Medicare about $1.77 a pill. Cuban charges about one tenth the price–$0.19 a pill.

    Here’s more from Just Care: