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Things to Keep In Mind About Specialty Drug Costs and Medicare

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    For those who are enrolled, or are planning on enrolling in Medicare Part D, many things should be considered, especially for those who may need high-cost prescription drugs. I found an article that definitely raised my eyebrow. People who require specialty drugs for sicknesses such as MS, hepatitis or cancer may be left with a good portion of the bill.

    Since 2006, Medicare Part D has helped to make medications affordable for millions of U.S citizens. Still, many have a hard time affording high out-of-pockets costs for their medications. According to the article, specialty tier drugs are defined by Medicare as drugs that cost more than $670 per month. Even though such drugs are taken by the minority of Part D enrollees, such an issue shouldn't be ignored because it touches or will touch all of us one way or another. Spending on specialty tier drugs have and will only increase as years go on. Right now, spending on such drugs takes up 20% of Part D spending, which is 6 to 7 percent since 2010.

    An excerpt from the article:

    "Median annual out-of-pocket costs in 2019 for 28 specialty tier drugs reviewed by Kaiser range from $2,622 for Zepatier (for hepatitis C) to $16,551 for Idhifa (for leukemia), based on a full year of use, according to the Kaiser analysis.

    Part D plans are allowed to charge between 25% and 33% coinsurance for specialty tier drugs before enrollees reach the coverage gap. Then they pay 25% of the cost of their drugs. Once their total out-of-pocket spending exceeds an annual threshold of $5,100 in 2019, enrollees pay 5% of the total drug costs above the catastrophic coverage threshold.

    In Mr. Sorkin's case, 5% of his $15,000-per-month drug cost translates into $750 per month. There is no upper limit on out-of-pocket spending."

    Then consider that there are still monthly premiums on top of that for both Part B and Part D. Not to mention, vitamins and supplements are not covered by insurance.

    Also we must consider that Medicare Part D out-of-pocket costs are only going to continue to increase if congress doesn't do something about it.

    "The annual threshold for the catastrophic level of drug coverage grew relatively slowly over the past decade, rising $550 since 2010 to the current level of $5,100 in 2019. But the threshold is scheduled to take an enormous jump of $1,250 next year, to $6,350, due to an expiring provision of the Affordable Care Act. Unless Congress steps in, the threshold before catastrophic drug coverage begins will continue to increase rapidly, reaching $9,450 by 2027."

    So what can you do? Check your health care drug plan options each and every year. Switch plans whenever it makes sense. Remember, Medicare open enrollment is from October 15th to December 7th of every year. Staying on top of this may save you a lot of money in the future.

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    JFoster Wrote:

    So what can you do? Check your health care drug plan options each and every year. Switch plans whenever it makes sense. Remember, Medicare open enrollment is from October 15th to December 7th of every year. Staying on top of this may save you a lot of money in the future.

    Higher Premiums Don't Bring Better Specialty Drug Coverage.

    This article leads me to assume that if your Medicare D coverage for specialty drugs starts to go up, or even if it doesn't, seriously consider changing over to a Medicare Advantage plan. They are more restrictive in some ways, but way cheaper monthly on average. All depends on the certain drugs you need covered, and where you live.

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    That's certainly a good point. Thanks for adding that in there. I could see where in some areas of the country it would be beneficial to stay with Part D.
Categories: Medicare Part D