Medicare Part D nightmares, continued


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.

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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

About Cary Byrd

eDrugSearch founder, Cary Byrd, has been called an “e-health innovator” by MarketIntellNow, interviewed by top pharmaceutical industry journalists, invited to Matthew Holt’s Health 2.0 Conference and a Consumer Report's health summit, and highlighted on numerous health blogs. - Search. Compare. Save.

0 thoughts on “Medicare Part D nightmares, continued

  • lost senrio says:

    You guys ought to take a look at These guys can keep a lot of people out of the donut hole. They have this cool thing where they take your existing drugs and make suggestions to your doctor about changing to cheaper ones. Its not about going without or running off to Walmart or other foolishness. Its about using our pharmacists and doctors to help us stay healthy for lower costs

  • Jamie Strong says:

    I was just dropped by my private insurance because my husband retired and I’ve been on SS Disability for years. I had been told that I did not have to use medicare as my primary if I maintained private insurance. Once private insurance found out, they dropped me (even though they’re still taking my money). Now I’m trying to figure out the whole medicare prescription nightmare and most of the drugs I take (chronic sciatic and back pain) have to get special exception approval before they’re filled. But I first have to select the program for scrips. It makes you want to just go shoot your brains out because it’s just too complicated. Compared to private insurance, the cost is astronomical! Is there some support group I can talk to that can help me through this? Help!!!!

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