We all know — or should know — by now that the Medicare prescription drug benefit (Medicare Part D) was crafted with the needs and convenience of Big Pharma, rather than patients, in mind. That’s why it’s so unwieldy for the consumer.
The worst part about Medicare Part D is the so-called “doughnut hole,” described by the Wall Street Journal as “the notorious gap in coverage … where (beneficiaries) generally must begin paying the full cost of their medicines. The doughnut hole kicks in when total drug expenditures by the beneficiary and the plan reach $2,510.”
Another egregious element of Medicare Part D, which has gotten less attention, is private “pharmacy benefit managers” charging Medicare beneficiaries MORE for prescription drugs than they cost at the pharmacy! These middlemen are ripping all of us off, too, since the taxpayers are picking up most of the tab. And by charging inflated prices, they push Medicare beneficiaries into the doughnut hole sooner.
Medicare is trying to fix the problem, but in the meantime, advocates for the elderly are advising them to buy at least some of their drugs outside the Medicare Part D plan.
Advises the Wall Street Journal:
Medicare drug-benefit participants buying drugs should consider checking low-price sellers of generic medications, such as Costco Wholesale Corp. and Wal-Mart Stores Inc., to see if their retail prices are lower than those in the insurance plan.
That is what Len Steinberg of Scottsdale, Ariz., did, and he found that Costco’s retail price for his generic nasal spray was about half of the drug’s total cost under his plan.
Mr. Steinberg, a 73-year-old retired employee-benefits consultant, says he now pays cash for certain cheap generics at Sam’s Club and Costco, rather than using his drug coverage. That allows him to avoid the doughnut hole and continue receiving coverage for his more expensive branded medications, he says.
Another option, of course, is to buy your medications from licensed Canadian pharmacies, where prices are on average about 50 percent less than the same drugs at U.S. pharmacies.
Image source: Senior Focus