However, the number of available drugs did increase somewhat, although the number approved by the FDA each year (around 53, or probably around 700-800 over the time period mentioned) is fairly small compared to the existing 20,000 or so FDA approved drugs.
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A plan covering fewer drugs isn’t necessarily a bad thing. For example, there is little reason for a plan to cover all (or most) TNF blockers.
Most drugs are not novel, so they are competing with other drugs in the same class and/or for the same disease when they launch. Judicious choosing between the various options by disease is necessary, no reason to cover 100% of the drugs out there for most indications. Of course there can be exceptions and for Part D plans, the government mandates they cover all drugs in certain categories.
Plans are trying to offer a product that is attractive to its customers and also keep costs down/affordable. It can be a tough balance when constructing a formulary, and impossible to make everyone happy.
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Ty this section caugjt my eye:
“Since 2014, the list prices of brand-name and generic drugs have increased by 37%, far outstripping the rate of inflation. This surge in prices includes not only the much-publicized gene therapies and specialized treatments but also everyday medications that people need for chronic conditions.
The lack of significant price decreases, coupled with poorer insurance coverage, has profound implications for patients. Many people are experiencing the financial strain of paying out of pocket for their medications, especially as insurance plans cover fewer drugs and impose stricter conditions on the medications they do cover. This situation results in rising out-of-pocket costs, medication nonadherence, delayed care, poor health, and inequitable access to healthcare.”
Interesting Opinion piece in USA Today by Sen. Bernie Sanders and President Joe Biden
“ As a result of the Inflation Reduction Act that passed Congress without a single Republican vote, seniors with diabetes are paying no more than $35 a month for insulin. Starting in January, no senior in America will pay over $2,000 a year for prescription drugs. And, for the first time in history, Medicare is now doing what every other major country does: Negotiate with the pharmaceutical companies to lower the price of some of the most expensive drugs in America.”
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Net prices are going down especially everyday medications. Drug Channels: Tales of the Unsurprised: U.S. Brand-Name Drug Prices Fell for an Unprecedented Sixth Consecutive Year (And Will Fall Further in 2024)
Now that the Feds can negotiate directly with drug companies, due to the Inflation Reduction Act, Medicare net costs for plans thru the govt should see some decreases too.
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Well that sure isn’t true considering that Medicare not only doesn’t cover the drugs Zepbound, Wegovy, etc., seniors are prohibited from even getting any discounts on those drugs via Good RX. These prescription drugs must be purchased at 100% of the price the pharmaceutical companies charge without any price negotiations with the government.
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I thought that being insured with Medicare Part D did not preclude people from using discount programs. But the cost paid is not applied to the person’s deductible.
https://www.goodrx.com/conditions/weight-loss/does-medicare-cover-weight-loss-medication
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I recently returned a drug (not weight loss) that I purchased using my Medicare Part D, because it was so much cheaper using a GoodRX coupon.
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If that’s true, it would be great news for people on Medicare who need those drugs. From what I’ve read, it’s not permitted for anyone on medicare, Medicaid or any state sponsored program to use Good Rx for any weight loss drugs in that class.
There are two separate issues here.
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Medicare Part D does not cover the weight loss drugs when used solely for weight loss. Many of the Part D plans DO cover the weight loss drugs for other conditions, such as diabetes or to prevent heart attack/stroke.
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Medicare prohibits the use of GoodRx or other types of co-pay coupons when used in conjunction with Medicare benefits.
Unfortunately, people enrolled in Medicare Part D are not allowed to combine drug manufacturer discounts and copay coupons with their prescription benefits.
https://www.goodrx.com/insurance/medicare/prescription-drug-savings-while-on-medicare-part-d
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So what does that mean? I am on a prescription medication now that isn’t covered by my insurance (I have one year to go til Medicare) and isn’t covered by most Medicare part d or Medicare advantage plans. Using goodrx I pay about $30/month which is not a big deal to me. But if I’m on Medicare, are you saying that I can no longer get this medication with my goodrx coupon?
I assume you can still get it without using your insurance as you are now (what I posted above clearly says medicare patients can’t COMBINE goodrx with their Medicare prescription benefits.) But I am not an expert, and would look to the goodrx site/customer service for guidance once you are covered by medicare.
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My H uses GoodRx and cash pay for one of his prescriptions. The prescription is on his Part D formulary, but the cost is ridiculous. The pharmacist at Costco lets him know which price is better at the time he fills the prescription - GoodRx or cash pay. With either method, it is filled outside of the Medicare system, so it is not counted toward his deductible or OOP (yes, it is out of pocket, but not for Medicare purposes). I would be surprised if there are any limitations on using a third party discount when paying outside of the Medicare/Part D system. But I could be wrong.
I don’t know how discounts from the pharmaceutical companies work if a patient has Medicare. It’s possible that the company prohibits using their discount programs if you have Medicare, but I don’t know for sure.
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Medicare patients can’t use discounts/copay cards, etc provided by the manufacturers if they are also using their Medicare prescription benefit to access the drug.
I’m in my first year of being on Medicare. I used a broker to sign up and followed her recommendation to sign up for WellCare’s ValueScript Plan D for my PDP, which has a $0 premium in my state. Most of my prescriptions are cheap generics, but for a few of them I am better off using a discount card instead of my WellCare plan. Fortunately my Kroger pharmacist is helpful in telling me which discount card (among those they accept) will give me the best price, usually Visory or SingleCare.
My broker also emphasized that it’s important to re-evaluate every year during open enrollment to see what PDP is best based on my current prescription list and the latest info on premiums and formularies for the various PDP options.
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Love the Wellcare ValueScript plan! Last year it was $11.50/month, but went down to $0.50/month this year. My mother was paying $104/month last year and gave me grief about changing to Wellcare; I finally wore her down. With routine meds like BP and cholesterol provided at no charge, and her other meds at $5/month, it was a no brainer. Her rescue inhaler while not on her formulary, is only $30 with Good Rx and she rarely uses it unless she is sick. She could never spend enough on medication to warrant spending over $1200/year in premiums.
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Thanks Kelsmom, this information is helpful and may clarify confusion over the wording on the websites stating that GoodRx can’t be used for weight loss prescriptions if the patient has Medicare. If the purchase is outside of the Medicare system, I can’t see why it would be any of Medicare’s business if the card is used.
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There was a time when our employer insurance pharmacy plan would not allow pharmacies to take a manufacturer discount coupon even when we paid cash outside of the insurance plan. (We probably could have transferred the prescription to a pharmacy that we had not previously used, but I was clueless back then.). This happened when our kids needed expensive topical acne medications in the early 2000’s. I remember that a law was passed prohibiting pharmacy benefit managers from doing this. I’m fuzzy on the details now, but I remember how great it was for us when the rules changed.
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It just blows my mind how complicated med plans are these days. As more meds are developed, I suspect things will get worse not better. Makes me a bit envious of what I picture as simpler schemes in other countries.
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Good news for those on certain medications. Between the cap on prescription drug prices and now a negotiated price, I’m hopeful for no more donut holes for those who are in this predicament
https://www.axios.com/2024/08/15/medicare-drug-price-negotiations-savings-announced
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I’m not old enough for Medicare, but my husband is studying Plan D options. His broker suggested he switch from a Humana plan to Wellcare, based on his list of regular meds (all generics). But we are trying to figure out the “risk” to doing so if he needs to start using a different pricey med.
I thought with the new cap it would mean $2000 max out of pocket. But it seems that is only true if it is one of the “covered med” (Wellcare formulary). I’m aware there are tools to check meds, but we are concerned about the What If situation of expensive unknown… the usual reason for insurance. The saving grace is that you can change Plan D choice each year (though it could be a pain to switch multiple prescriptions)/