{"id":7028,"date":"2022-08-03T07:35:45","date_gmt":"2022-08-03T11:35:45","guid":{"rendered":"https:\/\/www.silvercentury.org\/?p=7028"},"modified":"2022-08-03T07:35:45","modified_gmt":"2022-08-03T11:35:45","slug":"your-medicare-drug-plan-can-hike-its-prices-almost-anytime","status":"publish","type":"post","link":"http:\/\/78.142.243.82\/~silvercentury\/2022\/08\/your-medicare-drug-plan-can-hike-its-prices-almost-anytime\/","title":{"rendered":"Your Medicare Drug Plan Can Hike Its Prices Almost Anytime"},"content":{"rendered":"

If you\u2019re assuming that the prices on your drug plan\u2019s list of medications won\u2019t change over the course of the year, you may have an unpleasant surprise coming. They can and often do change. That\u2019s allowed except during the first few weeks after the enrollment period ends. Journalist Susan Jaffe, a contributing writer for<\/span><\/i> Kaiser Health News<\/span><\/a>, explains the rules and their consequences here. KHN posted her story on May 3, 2022, and it also ran on <\/span><\/i>NPR<\/span><\/a>. Funding from the Silver Century Foundation helps <\/span><\/i>KHN <\/span>develop articles (like this one) on longevity and related health and social issues.<\/span><\/i> <\/span><\/p>\n

Something strange happened between the time Linda Griffith signed up for a new Medicare prescription drug plan during last fall\u2019s enrollment period and when she tried to fill her first prescription in January.<\/span><\/p>\n

She picked a Humana drug plan for its low prices, with help from her longtime insurance agent and Medicare\u2019s Plan Finder, an online pricing tool for comparing a dizzying array of options. But instead of the $70.09 she expected to pay for her dextroamphetamine, used to treat attention-deficit\/hyperactivity disorder, her pharmacist told her she owed $275.90.<\/span><\/p>\n

\u201cI didn\u2019t pick it up because I thought something was wrong,\u201d said Griffith, 73, a retired construction company accountant who lives in the Northern California town of Weaverville.<\/span><\/p>\n

\u201cTo me, when you purchase a plan, you have an implied contract,\u201d she said. \u201cI say I will pay the premium on time for this plan. And they\u2019re going to make sure I get the drug for a certain amount.\u201d<\/span><\/p>\n

But it often doesn\u2019t work that way. As early as three weeks after Medicare\u2019s drug plan enrollment period ends on Dec. 7, insurance plans can change what they charge members for drugs\u2014and they can do it repeatedly. Griffith\u2019s prescription\u2019s out-of-pocket cost has varied each month, and through March, she\u2026 paid $433 more than she expected to.<\/span><\/p>\n

A <\/span>recent analysis<\/span><\/a> by AARP, which is lobbying Congress to pass legislation to control drug prices, compared drugmakers\u2019 list prices between the end of December 2021\u2014shortly after the Dec. 7 sign-up deadline\u2014and the end of January 2022, just a month after new Medicare drug plans began. Researchers found that the list prices for the 75 brand-name drugs most frequently prescribed to Medicare beneficiaries had risen as much as 8 percent.<\/span><\/p>\n

When insurers get discounts from drug companies, that doesn\u2019t necessarily result in lower prices for consumers. <\/b><\/p><\/blockquote>\n

Medicare officials acknowledge that manufacturers\u2019 prices and the out-of-pocket costs charged by an insurer can fluctuate. \u201cYour plan may raise the co-payment or coinsurance you pay for a particular drug when the manufacturer raises their price, or when a plan starts to offer a generic form of a drug,\u201d the <\/span>Medicare website<\/span><\/a> warns.<\/span><\/p>\n

But no matter how high the prices go, most plan members can\u2019t switch to cheaper plans after Jan. 1, said Fred Riccardi, president of the <\/span>Medicare Rights Center<\/a>,<\/span> which helps seniors access Medicare benefits.<\/span><\/p>\n

Drug manufacturers usually change the list price for drugs in January and occasionally again in July, \u201cbut they can increase prices more often,\u201d said <\/span>Stacie Dusetzina,<\/span><\/a> PhD, an associate professor of health policy at Vanderbilt University and a member of the Medicare Payment Advisory Commission. That\u2019s true for any health insurance policy, not just Medicare drug plans.<\/span><\/p>\n

Like a car\u2019s sticker price, a drug\u2019s list price is the starting point for negotiating discounts\u2014in this case, between insurers or their pharmacy benefit managers and drug manufacturers. If the list price goes up, the amount the plan member pays may go up too, she said.<\/span><\/p>\n

The discounts that insurers or their pharmacy benefit managers receive \u201cdon\u2019t typically translate into lower prices at the pharmacy counter,\u201d she said. \u201cInstead, these savings are used to reduce premiums or slow premium growth for all beneficiaries.\u201d<\/span><\/p>\n

Medicare\u2019s prescription drug benefit, which began in 2006, was supposed to take the surprise out of filling a prescription. But even when seniors have insurance coverage for drugs, advocates said, many still can\u2019t afford them.<\/span><\/p>\n

Insurers are replacing co-pays\u2014which are set amounts\u2014with coinsurance, which charges you a percentage of the price of the drug.<\/b><\/p><\/blockquote>\n

\u201cWe hear consistently from people who just have absolute sticker shock when they see not only the full cost of the drug but their cost sharing,\u201d said Riccardi.<\/span><\/p>\n

The potential for surprises is growing. More insurers have eliminated co-payments\u2014a set dollar amount for a prescription\u2014and instead charge members a percentage of the drug price, or coinsurance, <\/span>Chiquita Brooks-LaSure<\/a>,<\/span> the top official at the Centers for Medicare & Medicaid Services [CMS], said in a recent interview with KHN. The drug benefit is designed to give insurers the \u201cflexibility\u201d to make such changes. \u201cAnd that is one of the reasons why we\u2019re asking Congress to give us authority to negotiate drug prices,\u201d she said.<\/span><\/p>\n

CMS also is looking at ways to make drugs more affordable without waiting for Congress to act. \u201cWe are always trying to consider where it makes sense to be able to allow people to change plans,\u201d said <\/span>Meena Seshamani<\/a>, MD,<\/span> CMS deputy administrator and director of the Center for Medicare, who joined Brooks-LaSure during the interview.<\/span><\/p>\n

On April 22, CMS unveiled a proposal to streamline access to the Medicare Savings Program, which helps 10 million low-income enrollees pay Medicare premiums and reduce cost sharing. Enrollees also receive drug coverage with reduced premiums and out-of-pocket costs.<\/span><\/p>\n

The subsidies make a difference. Low-income beneficiaries who have separate drug coverage plans and receive subsidies are nearly twice as likely to take their medications as those without financial assistance, according to <\/span>a study<\/span><\/a> Dusetzina co-authored for <\/span>Health Affairs<\/span><\/i><\/a> in April.<\/span><\/p>\n

I finally just had to give in and pay it because I need the meds \u2026<\/b><\/p>\n

\u2014Linda Griffiths<\/b><\/p><\/blockquote>\n

When CMS approves plans to be sold to beneficiaries, the only part of drug pricing it approves is the cost-sharing amount\u2014or tier\u2014applied to each drug. Some plans have as many as six drug tiers.<\/span><\/p>\n

In addition to the drug tier, what patients pay can also depend on the pharmacy, their deductible, their co-payment or coinsurance\u2014and whether they opt to abandon their insurance and <\/span>pay cash<\/a>.<\/span> <\/span><\/p>\n

After Linda Griffith left the pharmacy without her medication, she spent a week making phone calls to her drug plan, pharmacy, Social Security and Medicare but still couldn\u2019t find out why the cost was so high. \u201cI finally just had to give in and pay it because I need the meds\u2014I can\u2019t function without them,\u201d she said.<\/span><\/p>\n

But she didn\u2019t give up. She appealed to her insurance company for a tier reduction, which was denied. The plan denied two more requests for price adjustments, despite assistance from Pam Smith, program manager for five California counties served by the <\/span>Health Insurance Counseling and Advocacy Program<\/a>.<\/span> They are now appealing directly to CMS.<\/span><\/p>\n

\u201cIt\u2019s important to us to work with our members who have questions about any out-of-pocket costs that are higher than the member would expect,\u201d said Lisa Dimond, a Humana spokesperson. She could not comment about Griffith\u2019s situation because of privacy rules.<\/span><\/p>\n

However, Griffith said she received a call from a Humana executive who said the company had received an inquiry from the media. After they discussed the problem, Griffith said, the woman told her, \u201cThe [Medicare] Plan Finder is an outside source and therefore not reliable information,\u201d but assured Griffith that she would find out where the Plan Finder information had come from.<\/span><\/p>\n

She won\u2019t have to look far: CMS requires insurers to update their prices <\/span>every two weeks<\/span><\/a>.<\/span><\/p>\n

\u201cI want my money back, and I want to be charged the amount I agreed to pay for the drug,\u201d said Griffith. \u201cI think this needs to be fixed because other people are going to be cheated.\u201d<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Something strange happened between the time Linda Griffith signed up for a new Medicare prescription drug plan during last fall\u2019s enrollment period and when she tried to fill her first prescription in January.<\/span><\/p>\n

Read more Your Medicare Drug Plan Can Hike Its Prices Almost Anytime<\/span> ›<\/span><\/a><\/div>\n

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