Medicare part II

Partly due to 1pg’s questions about Medicare, I have a question.

What is it with the increased interest in Medicare being able to negotiate prices on prescription drugs? Stand alone Medicare doesn’t even cover prescription medication unless it is administered as an IV or by a hospital if you are an admitted patient. Neither of these scenarios has any effect on the prices the retired folks standing in line to pick up their prescriptions at Walgreens.

So what are the details of this?

Thanks
wolferd

Take a look at Part D. It’s an optional part of “stand alone Medicare”.

-IGU-

If you have to deal with cancer, significant coronary issues, some chronic GI tract issues it is not hard to spend a thousand dollars a month. Hit one of the new biologics and you you are over $100K a year.

Today health care is 20% of the US economy. Prescription drugs at 2.4% up from 0.5% 25 years ago. People don’t go into Canada by the bus load to purchase drugs because they want to deal with customs when they cross the boarder.

Do people still do that…go to Canada to buy cheaper Rx drugs? I thought that somehow got seriously outlawed. I haven’t heard of anyone doing this in years.

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Take a look at Part D. It’s an optional part of “stand alone Medicare”.

I understand that and I have Part D coverage.

But it is offered through an insurance company and every company that offers it negotiates the prices. The prescription costs in Plan D are already negotiated.

Would Medicare negotiate the price and the companies that provide those policies then have to use those negotiated prices? Would it also apply to Medicare advantage plans?

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If you have to deal with cancer, significant coronary issues, some chronic GI tract issues it is not hard to spend a thousand dollars a month. Hit one of the new biologics and you you are over $100K a year.

Today health care is 20% of the US economy. Prescription drugs at 2.4% up from 0.5% 25 years ago. People don’t go into Canada by the bus load to purchase drugs because they want to deal with customs when they cross the boarder

I understand that, but Medicare itself does not cover prescription drugs, so what does allowing Medicare to negotiate the price mean? Insurance companies that provide supplemental prescription coverage already negotiate prescription prices.

Here you go.

Under H.R. 3, the Secretary of Health and Human Services (HHS) would be authorized to negotiate directly with drugmakers in the Medicare program for lower prices for up to 250 prescription drugs each year, including the 125 most costly drugs offered by Medicare Part D plans or sold anywhere in the commercial market. This authority would apply to brand-name drugs that have little or no competition from generic or biosimilar medicines as well as to all insulin products.

https://www.commonwealthfund.org/publications/explainer/2021…

Andy

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Anything that is legal in the United States can be bought in Mexico or Canada. Just need to make sure the one you are buying is ok and you can’t buy more than a 90 day supply. Mexico sells alot of drugs directly over the counter that you would need a prescription for in the United States.

Andy

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wolferd1

But it is offered through an insurance company and every company that offers it negotiates the prices. The prescription costs in Plan D are already negotiated.

Insurers may be beating the bushes to get the best price on the drugs they’re buying, but what they’re selling to you is often 3 or 4 times the price you’ll get from GoodRx or Mark Cuban’s CostPlus Drug Company.

Medicare Part D is basically a scam for the benefit of the insurance companies.

The only Medicare drug benefit I see in the Inflation Reduction Act is the $2,000 annual cap on Catastrophic Drug coverage. Under current law, there is no limit on what you’ll pay if you’re prescribed a drug with a $100,000 or $500,000 price tag.

Of course, Catastrophic Drug coverage doesn’t kick in until you’ve already spent $7,050 out-of-pocket for the year with your Medicare Part D insurer. So it’s really a $9,050 annual out-of-pocket cap, not $2,000.

intercst

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Do people still do that…go to Canada to buy cheaper Rx drugs? I thought that somehow got seriously outlawed. I haven’t heard of anyone doing this in years.

The only thing that shut down Canadian prescription drug travel was COVID restrictions at the border. Canadian officials didn’t want the large petri dish of unvaccinated Americans infecting their country.

You can also get your Canadian prescription drugs by mail order. Every once and a while US Customs kicks an order back to Canada, but your Canadian pharmacy will just repackage it and send it back to the US. Your order will usually make it through on the second trip.

It’s such a big business that they now have a lobbying group.

https://en.wikipedia.org/wiki/Canadian_International_Pharmac…

intercst

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intercst,

Insurers may be beating the bushes to get the best price on the drugs they’re buying, but what they’re selling to you is often 3 or 4 times the price you’ll get from GoodRx or Mark Cuban’s CostPlus Drug Company.

Medicare Part D is basically a scam for the benefit of the insurance companies.

There are more different kinds of drugs than there are people so I doubt there is any such thing as a typical experience. But I’ll just say that what you have posted is certainly not accurate in my case. I have checked both GoodRX and the Mark Cuban plan against what I take several times. The CostPlus cost for my medication is almost exactly the same as my UHC plan, GoodRX was not helpful, though it was for something my wife took.

In addition to that, I have no out of pocket expense for my medication if I purchase it mail order through OptumRX. That works very well and is the slam dunk winner in my case.

I’m sure there are other stories with different results, but that is mine. It doesn’t seem like a scam to me.

wolferd1 writes,

<<Insurers may be beating the bushes to get the best price on the drugs they’re buying, but what they’re selling to you is often 3 or 4 times the price you’ll get from GoodRx or Mark Cuban’s CostPlus Drug Company.

Medicare Part D is basically a scam for the benefit of the insurance companies.>>>

There are more different kinds of drugs than there are people so I doubt there is any such thing as a typical experience. But I’ll just say that what you have posted is certainly not accurate in my case. I have checked both GoodRX and the Mark Cuban plan against what I take several times. The CostPlus cost for my medication is almost exactly the same as my UHC plan, GoodRX was not helpful, though it was for something my wife took.

If Medicare Part D is really giving you the best price on the basket of medications you take, congratulations – you’ve won the lottery.

That’s not the experience for most beneficiaries, thus the success of GoodRx, etc.

intercst

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I have checked both GoodRX and the Mark Cuban plan against what I take several times. The CostPlus cost for my medication is almost exactly the same as my UHC plan, GoodRX was not helpful…wolferd1

Same here. I take two prescription meds to manage a relatively rare disease. Both are Tier 4 with no generic. Good Rx prices are within a couple of dollars of my Medicare Part D prices after the deductible is met.

Since I’m paying $720 every 90 days to refill them you can be sure I’m always looking for some way to get them cheaper.

tsimi

“Stand alone Medicare doesn’t even cover prescription medication unless it is administered as an IV or by a hospital if you are an admitted patient. Neither of these scenarios has any effect on the prices the retired folks standing in line to pick up their prescriptions at Walgreens.”


Not exactly the case.
Part B covers diabetes testing supplies as well as medication used via inhalation -
e.g. albuterol.

Howie52

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tsimi writes,

<<I have checked both GoodRX and the Mark Cuban plan against what I take several times. The CostPlus cost for my medication is almost exactly the same as my UHC plan, GoodRX was not helpful…wolferd1>>

Same here. I take two prescription meds to manage a relatively rare disease. Both are Tier 4 with no generic.

GoodRx only provides value on generic drugs, it rarely does anything for you with expensive name brand drugs.

Of course, 90% of the prescriptions seniors fill are for generic medications. So GoodRx, Blink.com, Mark Cuban’s CostPlus Drugs, etc. are saving money for a lot of people.

intercst

Yeah. CostPlus is only generics.

So basically you have to gamble when you turn 65. Will you need a brand drug (in which case you likely will need Part D), or will you only need generics (in which case CostPlus is hard to beat, if they carry your med)?

Pick wrong, and you lose a lot of money.

Yeah. CostPlus is only generics.

So basically you have to gamble when you turn 65. Will you need a brand drug (in which case you likely will need Part D), or will you only need generics (in which case CostPlus is hard to beat, if they carry your med)?

Pick wrong, and you lose a lot of money.

Not really. You can have your cake and eat it, too.

Just buy the cheapest Part D plan available in your zip code ($7.70/month where I live), then buy your generic drugs from GoodRx, Mark Cuban, etc. when it’s cheaper than your price gouging insurer.

I save about $1,000/yr with this strategy versus assuming that the thieving insurance company is giving you the best price.

intercst

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So basically you have to gamble when you turn 65. Will you need a brand drug (in which case you likely will need Part D), or will you only need generics (in which case CostPlus is hard to beat, if they carry your med)?

Well, UHC offers three plans in my county. The least expensive is $29.30 per month, no copay or deductible on tier 1 meds, $310 deductible on tier 2-5. As I mentioned previously I have started using mail order and have no out of pocket costs, though I do not need a high cost name brand drug. But for $30 a month I don’t think it is much of a gamble.

Yes there is a formulary, though I have never needed anything they didn’t cover. I’m sure others have run into that. I just know it is working well in my case.

), then buy your generic drugs from GoodRx, Mark Cuban, etc.

Yeah, well you gotta watch out for them, too. BTW, you don’t “buy” your drugs from Goodrx. They just tell you where it’s the cheapest and give you a code.

We had a 12 month prescription where Goodrx directed us to Kroger. But the pharmacist said they would only give us 3 months worth of it at a time. No problem…except they charged us the 3-month price which was higher per pill. Sigh, okay, whatever.
Got the next 3 month supply 3 months later. Fine.

Next time, Kroger said, “Oh, we don’t take the GoodRX price anymore, it’s a higher price now. But we can still fill it, because you have 6 months left on the RX.”
New price was twice as much.
But they have our RX, and it’s a PITA to transfer it to another (cheaper) pharmacy.

I save about $1,000/yr with this strategy

You must be taking a lot of drugs, or some quite high priced drugs. Between the two of us we take a ton of drugs, heart pills, etc. and don’t pay anywhere near $1,000 in a whole year. Let alone saving $1000 by using GoodRX.

Unless, perhaps you are shading the truth a little bit???

Yes there is a formulary, though I have never needed anything they didn’t cover.

Our Humana plan has a formulary. My heart doctor recently switched me from a Tier 1 (free) pill to one that isn’t in the formulary.
Humana sent me a letter explaining that it wasn’t in the formulary so it wasn’t in any Tier, but they’d fill it for me but it would cost something and they’d let me know how much I owed them.

A week later, they sent a letter that said my price on this out-of-formulary drug was … $0.00 per 90 day supply.

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