Making smart Medicare Part D choices

Seniors reeling from the financial crisis and looking to pare living expenses should take a fresh look at their prescription medicines and Medicare Part D plan. Significant savings are possible and the timing is right: The 2009 open enrollment season for Medicare Part D (the prescription drug benefit) began Nov. 15 and runs through Dec. 31.   

Our analysis has found that seniors can save from hundreds to thousands of dollars a year–and possibly keep themselves out of the infamous benefit gap known as the doughnut hole–by switching to lower-cost medicines (such as generics) and carefully picking a Part D plan.

The Consumer Reports Best Buy Drugs team looked at more than 250 Part D plans in six cities (by ZIP code) using Medicare’s “plan finder” tool. Our study found that enrollees who take medicines in 2009 for diabetes, heart disease, high blood pressure, high cholesterol, and arthritis (a not-all-that-uncommon mix of medical conditions for those over age 65 or so) could save in the neighborhood of $5,000 a year by switching to effective alternative nonbrand drugs. (Actual savings depend on where you live, your Part D plan, and the specific drugs you take, as well as your doctor’s judgment that you can, indeed, make the switches.)

Part D enrollees with just one chronic condition can also shave their out-of-pocket costs. Our analysis found, for example, that a senior with type 2 diabetes in Phoenix could save from $497 (lowest-cost plan) to $737 (highest-cost plan) if he or she was taking the brand-name drug Januvia, but switched instead to metformin, a generic drug. Likewise, a senior with arthritis in Atlanta who was taking just one drug–the brand-name drug Celebrex–but switched to ibuprofen, another generic drug, could save from $555 to more than $1,500, depending on his or her choice of plans.

In the past two years, the vast majority of seniors have re-enrolled in the Part D plan they are in. But the government agency that runs Medicare and the drug benefit (the Centers for Medicare and Medicaid Services) is advising people this year to shop around. The main reasons: 

• Premiums are rising across the board in 2009, with some plans charging an estimated 60 percent more than they did in 2008. They’ll range from around $10 a month for some minimalist plans to more than $100 a month for comprehensive plans.
• Over the years, plans have been changing their formularies, co-payments, and cost-sharing (the amount you pay out of your own pocket). This is critical, because the main expense in many Part D plans are the co-payments, not the monthly premium (assuming you need to take any medicines at all). 
• A few plans are dropping coverage of select generic drugs in the Part D doughnut hole. In 2009, the doughnut hole kicks in when your drug expenses (what you and the plan together spend) hit $2,700. The gap continues until you have spent $4,350 out of your own pocket. So, for people who have to take many drugs, and especially expensive brand-name drugs, the doughnut hole can loom very large indeed, and should be the central issue in their choice of a Part D plan.   

The government's Web site for the Part D benefit will lead you to the basics about Medicare Part D plans. You’ll find the plan finder there as well.

For more advice, read our full report and see our tips for choosing coverage (PDF download). Another site we like is Medicarerights.org, sponsored by the Medicare Rights Center, a nonprofit, consumer-oriented group. Avoid sites sponsored by individual Part D plans; most aim to sell you their coverage. Be wary also of ads and sales pitches from insurers and insurance brokers. A federal government review recently found that most of the written materials that Part D insurers had prepared last year failed to meet government marketing guidelines for accuracy and clarity. 

—Steve Findlay, managing editor, Best Buy Drugs

Comments

[Medicare Advantage]

A few additional points for Medicare Beneficiaries – Many states have Pharmaceutical Assistance Programs (SPAP) with income limits higher than those of Medicaid. These are state programs and enrollment is not via the Social Security Administration. Check with your state website for details. http://www.statehealthfacts.kff.org/profile.jsp

Also,

Medicare beneficiaries should be aware (if not angry) that getting advice on Part D and Medicare Advantage Plans will be much tougher in 2009.

Just 4 days prior to the Annual Enrollment Period (AEP) the Center for Medicare and Medicaid (CMS) instituted a mandatory cut in compensation to independent advisors educated and certified to assist Medicare beneficiaries in their enrollment. In PA NJ or DE try this organization: http://www.mysenioradvisorsgroup.com/

In a further demonstration of socialism in America CMS has forced independent advisors out of the business, leaving little objectivity behind. Come 2009 many of the better qualified, and experienced agents will flee the Medicare advice business and focus their business efforts in areas where they are fairly compensated. Having committed resources many professionals were already committed to what was transformed in November 2008 into a losing proposition. (CMS change came days before in a most unprofessional implementation – Credit card companies by example have been given 18 months before their industry modification takes effects)

Many professional qualified advisors had no other choice but to remain involved for the 2008 Annual Enrollment Period. However, this ruling did not apply to the biased insurance company employees – (Can you say “political contributions”) - they will be compensated at about 10x the amount of independent advisors when you include all cost and expenses So beware; the less objective insurance company salesmen will gladly enroll you in the company policy but don’t expect them to tell you if there is a better choice. How’s that for looking out for the senior population?

Medicare beneficiaries are strongly encouraged to contact their representative and tell them that advice on Medicare Advantage and Medicare Rx plans is extremely important! That in democratic, capitalist system the market should determine profits and loses and government should protect and regulate only policy and procedure. CMS has created a vacuum of advice that will likely be filled by less qualified, biased, and/or unethical individuals. Certainly the Medicare Advantage program has issues but the policies and regulation devised to correct the problems are amateurish, naïve, and plain sophomoric. I have proposed additional oversight that would weed out the bad apples, rein in cost and improve benefits for Medicare Beneficiaries. CMS seems more intent on punishing every agent and beneficiary to weed out a few problems. Sounds like a solution my eight grader might devise.

Contact your local representative and/or Representatives: Stark, Grassley, Baucus, Hatch, and Rockefeller. For additional comments and contact information on the topic see....
http://medicareadvantageplan.blogspot.com/

[Kathy Nail]

Most all of these comments I have read give excellent advice. Please remember YOU are your best advocate, so you need to be an active participant in your 3rd party (medicare ins.), doctor, drug, &/or pharmacy choices. Please read all of the "fine print" of your plan and formulary. Your doctor and pharmacy have restrictions (put in place by YOUR plan) and laws they MUST abide by. If you don't like those restrictions, you have a choice of battling the with the provider of the plan OR paying for the drugs in question. REMEMBER, the pharmacist/pharmacy has no control over the copays, "dough-nut hole", charges, etc. put into place by the plan. They are told what they will be paid (which is rarely enough to pay costs involved) as well as what to charge you; often resulting in a net loss to them. Be assured that your pharmacist and doctor are working long, hard hours, often on "prior authorizations" and other time consuming tasks as well as providing the best medical care to you, to be paid less and less. A side note: pharmacists, doctors, & others in the medical profession are consistently chosen, by the public, as being "most respected" professions.

[Dave]

How is it that the rest of the developed world can get cheap yet high quality health care - all we get is duped and used by those all those corporations that are "Saving our lives.."? The system is so broken, it's not even worth saving. Pitch the entire system, bring on the Tawanese or French model, retrain all the health insurance executives to perform valuable and rewarding new entry level jobs in our flowering service economy.

[alice Fellows]

I am very unhappy with Humana,mostly because they keep raising premiums (tripled over 2 years) and provide statements with a 2-month lag time( I received the statement for the period ending September 30 on December 1!) so that you never know how close you are to the donut hole unless you keep excellent records. There are also problems with December orders; often they "mistakenly" put it into the next calendar year's total, even if you are not anywhere near the donut hole. So I am looking for a better plan, am considering AARP's plan via United Health, hoping they will be more accountable. Any suggestions/comments/criticisms would be greatly appreciated.

[Helen Romer]

I too tried to buy the $4 Walmart generic drugs, BUT the four generics I take daily are NOT on their $4 list. I also take five very expensive brand drugs that have no generic replacements. I not only reached the donut hole, but have been in the catastrophic stage for months and the 5% charges, are in some cases, more costly than my original co-pay prices. Go figure that one out--I can't!!!!!

[Arleang]

I am so happy to have found this site! I am looking around for a company other than Humana. Can anyone living in northern or central California make a recommendation?

We had the unhappy experience of being told my husband could not have his Advair because it wasn't time yet. They said he had received three units when he had only been given one, and the infuriating part is that they will not sell you the medication even if you want to pay cash!

Well, we got it sorted out, but in the meantime my BP must have been sky high. We were better off ordering from Canada.

[EVE Rider]

All this suggestion are wonderful, for people that have only generic drugs.
My husband has several drugs that are not generic, and cannot be bought in this country as generic drugs.
We received a Drug Pharmacy card to get one Prescription $ 50.00 off, but still have to pay up to 108 .00 on our own. It seems not only are we in the hands of the Pharmacy but the Pharmacist, that OK's or not Ok's the transaction. We are fighting every 28 days over this problem. As the doctor refuses to write any higher prescriptions. Not allowed for this Drug.
I have to watch each time with any prescription that I get the correct price. as I have a Plan D and a AARP card that comes free. So that I have to watch , not the Pharmacy?? what price is the best for each drug.
Any suggestions will be appreciated. My husband falls into the Donuthole every year.

[Richard H]

Forget Plan D all together. Drop it and go strictly generic, which is usually possible. Then go to Walmart or any of the other stores that advertise the four dollar deal. You will save bunches of money and you don't have to mess with that expensive and bungled red tape tangled plan that Bush put in place to make the drug makers richer.

[Kathryn Hayes]

Another way to save on drugs is to not take them. The human body never died for a lack of any synthetic drug and the liver, kidneys, brain and other organs will be happier without them. In fact drug use over time destroys health and well being and leads to more drug use. Almost every problem your body can encounter can be treated with herbs, minerals, vitamins or other natural substances that actually help to heal. I know most doctors do not believe this, but there are a few who know that their education is sorely lacking in this area. (The elephant in the middle of the room that no one mentions.) Unless you have a dread disease or condition and can't possibly go another route, try some simple remedies that mother nature put on the planet along with us and see how freeing it can be. The library and the internet and your great grandmother are brimming with this knowledge. Check it out!

[Don P]

Medicarerights.org is essential reading to understand how Medicare Part D has failed so many people. It has put small pharmacies out of business because the participating insurers don't pay them in a timely manner. Drug costs and premiums have risen, not fallen, since the Part D program started. The constant insurance company pressure to switch seniors from a stand alone Part D program to a Medicare Advantage program that earns them much higher government compensation is criminal. Drug companies spend more than twice as much on marketing as they do on R&D. Their profits are averaging 16% when the Fortune 500 average is 6%. They are not "saving lives" organizations. They are flim flamming us with new drugs that have minimal therapeutic value compared with their risk and cost. Another excellent website on our broken health care system is www.ourailinghealthcare.com. Dr. Paul Hochfeld, a local ER physician makes the best presentation you will ever see about why health care for profit is breaking our health care system.

I recommend www.pharmacychecker.com to compare out of U.S. pricing. Check U.S. state government websites for approved lists of Canadian mail order drug suppliers. Some governors still have a backbone. Great article, Steve Findlay.

[Kurt]

What tier is your drug in? Is it in the formulary? What is your co-payment? Have you reached the Doughnut hole? What is your monthly payment?

Get rid of this crazy, money wasting insurance (insurance that you'll pay too much for) and buy generics or go to Mexico like I do. OOPS, the FDA doesn't like Mexican drug. They don't tell you that most of the drugs we get (and Mexico too) are made in India, Pakistan, China, etc. Remember the bad Heparin from China?

I found the drug prices the insurance charges toward your yearly limits are ridiculously high, even for generics, so you'll reach your doughnut hole sooner. Only in the US will you find such a crazy insurance scheme. No wonder, the guy who developed the plan for Bush now makes millions working for Big Pharma.

[Barb Johnson]

I am absolutely disgusted with my Medicare D Plan through Humana. Each year I have been with them, my drug costs have gone up over 20 percent. My monthy premium has tripled. I mailed a prescription for Oxycodone, which they should have easily recieved in a week. At the end of 7 days I received a call saying that Oxycodone will not be covered next year on the Medicare D Plan. Also, coincidentally, thay have not received any prescription for Oxycodone from my physician. In the past, they have lost the prescriptions for it, sent it to the wrong address 4 times, and I am usually in agony for at least 2 weeks, waiting for their processing. Once, out of the four times, I did not get my prescription, as someone else obviously kept it. I have been "shorted" by a few pills here and there in all my scripts. I have also noticed other medications differ in color and size from script to script, and some are so fragile, or dried out, that they "powder" the entire inside of the container during shipping. Beware of Humana, they use bait and switch tactics, are rude, and irresponsible with narcotic prescriptions and others.

barb

[A-L]

I get some of mine at Fred Meyer here in the northwest.

[Amber]

I just checked out Walgreen's $4 generic plan and they specifically exclude Medicare recipients. Any suggestions?

[Judith]

I am satisfied with my Medicare part D coverage except for one glitch: 4 times I was charged for a drug I do not use, bought in a state where I do not live. The person on the phone was helpful and all was corrected. However, I urge all to check their monthly statements carefully and not assume that all is as it should be..

[Jennifer Mc]

I've saved literally thousands of dollars on brand name medications by going through the drug companies themselves. Services such as needymeds.org have been invaluable. One of my brand name medications now costs me $30 for a 3 month supply - when in the donut hole, without assistance, one month was over $400. These programs are not as well publicized as they should be.

[May Lipe Mintz]

Mr. Fagin, how do you order medicine from overseas? I've switched to generics on most of my drugs, but I still have two (rozerem and byetta) that have no generic brand and are sky high in price.

[Jay Fagin]

Since my wife uses a few very expensive inhalers for her COPD and other breathing problems I have found that using a Part D with generic copay during the the gap and buying the expensive inhalers from overseas during the gap saves us very big dollars even though we pay for the insurance in the last 6 months without using it for the expensive drugs. One 90 day supply of Advair inhaler (cost about $700 in the gap) was $219 delivered from overseas and made by the same Glaxco Kline so in that one purchase it was less expensive even with the last 6 months of insurance payment, and we still got coverage for generics during that time.

[Kenny Hayes]

RIGHT ON THE MONEY!
Robert Fernie's suggestion (Nov 19, 2008 4:05:14 PM) is right on the money! I found that my Dad can save over $1000 by not using the Medicare Part D plan for his cheaper drugs. The key is to limit the Medicare plan to the most expensive drugs that total $2700 (the amount needed to reach the gap or donut hole) -- then get everything else the cheapest way possible.
As a SHIIP (Senior Health Insurance Information Program) volunteer here in NC, I also found that one lady I helped would save $1700 by getting all but her 2 most expensive drugs at WalMart or even retail prices.

[Robert Fernie]

Another way to save a lot is to buy generic medications from major pharmacies such as Walmart, Target and many pharmacy and grocery store chains through their special generic drug plans that charge $4/mo and $10/three mo supplies, not through the Medicare Part D plan. That can greatly reduce the medication cost calculated by the Medicare Part D plan that is used to determine when the person reaches the doughnut hole, thereby leaving more money to pay for non-generic medications.