One in four Americans report difficulty paying for medications. This is due in part to a 13 percent increase last year in spending on prescription drugs by individuals. Seniors are somewhat shielded from rising drug prices by Medicare’s Part D program, but drug cost stability for seniors is starting to reverse as newer specialty drugs come into the marketplace, according to Juliette Cubanski, a senior Medicare policy researcher for the Kaiser Family Foundation. There are also price spikes for a handful of generics. Increases in generic prices “may turn out to be the more significant problem” than specialty drugs, the chairman of the Massachusetts Health Policy Commission, Stuart Altman, recently said. They include new breakthrough drugs that cure, rather than just treat, Hepatitis C. Breakthrough drugs are also available to treat rheumatoid arthritis, multiple sclerosis and cancer.
For seniors, a Part D plan is key to how much individuals pay out-of-pocket, with medications being placed into price tiers. As high-cost specialty drugs come onto the market, Part D plans usually place them in the highest tier, causing seniors to pay a higher portion as their percentage of the price. This can place seniors into the “Donut Hole” more quickly. To prevent being subject to higher drug prices, seniors are urged to compare their specific prescriptions every time they re-enroll in Part D, especially tracking the cost of high-cost specialty drugs that may or may not be covered by their current Part D plan. One problem occurs when a physician prescribes a high-cost specialty drug that isn’t covered by the senior’s current Part D plan. Surprise! The senior needs the medication now but has to wait until open enrollment to find a plan that does cover it. For more information go to:
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