Some California beneficiaries have found lower prices for their prescription drugs in the open market than those negotiated by their Part D plan. Two such cases have recently been brought to our attention.
One example is with a drug, Finasteride. A beneficiary found that it cost her 2.5 times more to get it in her Part D plan than at Costco. Therefore, she bought her prescription at Costco instead of using her Part D plan. Subsequently, what she spent at Costco was not counted toward her TrOOP (true out-of-pocket expenses). In this case, it happened to be a plus for her since it delayed her entrance into the coverage gap, or donut hole.
In another case, a beneficiary’s Part D plan drug copayment was higher than the retail price for the same drug outside the plan.
We have notified the Centers for Medicare and Medicaid Services about this issue. Yet, it’s unclear what CMS can do since the Medicare Modernization Act (MMA) of 2005 prohibits the federal government or the Secretary of Health and Human Services (HHS) from negotiating Part D drug prices.
If you hear of additional cases like this, let us know. You can also contact your Congressional Representative or Senator to voice your concern on this issue.
September 27th, 2011 at 3:44 pm
I am 72 years old and very, very, very confused. I have been looking for a part D plan. The cost of subscribing to the plan together with the monthly premiums and the actual drug are more expensive than simply going to the pharmacy without a plan and buying the drugs retail. Is there something that I am missing. Every plan that I investigate is the same. Why have a plan? Please answer me by email, I am absolutely beside myself with worry.
September 30th, 2011 at 1:55 pm
Hi Patrick,
Thanks for your question. It is a good one. While having Part D drug coverage is voluntary, if you don’t sign up for a Part D plan when first eligible and then later decide you want to, you may incur a penalty. See http://www.cahealthadvocates.org/drugs/enrollment.html#Penalties
Also, you would have to wait until the Annual Election Period to enroll in a plan — this is from Oct. 15 – Dec. 7 of each year, with coverage starting on January 1st.
I suggest contacting your local Health Insurance Counseling and Advocacy Program (HICAP). They offer free individual counseling and assistance with Medicare and other health insurance related issues. Here’s a link to the HICAP offices by county: http://www.cahealthadvocates.org/HICAP/index.html
There is a lot of information out there and the system is complex; talking your options through with a HICAP Counselor may help clear things up as to what is your best choice.
Thanks again for contacting us.
All the best.