WASHINGTON (AP) — With three weeks left for seniors to change their Medicare
prescription plan for 2012, a new study brings distressing news: Copays for
brand-name drugs are going up — sharply in some cases.
Copays for preferred brand-name drugs will increase by 40 percent on average
next year, and non-preferred brands will average nearly 30 percent more,
according to the study by Avalere Health. Copays are the portion of the cost
of each prescription that the customer pays the pharmacy.
Avalere, a data analysis firm that serves industry and government, says its
findings show that Medicare prescription plans are steadily shifting costs
to chronically ill patients who need more expensive kinds of medications. At
the same time, the plans are trying to keep costs in check for the majority
whose conditions can be managed with less-expensive generics.
The changing scene underscores how important it is for seniors to check
their prescription coverage before open enrollment ends Dec. 7.
Medicare announced this summer that premiums for prescription plans would
remain unchanged next year, an average of about $30 a month. But the
government’s numbers didn’t delve into detail on copays. The Avalere study
shows that the plan with the lowest monthly premium may not always be the
“Seniors need to look beyond the premium to understand their drug benefit,”
said Avalere CEO Dan Mendelson. “The more the cost burden gets shifted onto
the patient who needs the medication, the more important it is for seniors
to understand that next level.”
Medicare officials took issue with the study, saying broad averages of
prices charged by drug plans don’t determine what an individual beneficiary
will end up paying.
“Everyone’s drug needs are going to be individual,” said Medicare deputy
administrator Jon Blum. “You can’t make a general conclusion until you look
at the particular plan they are in and the particular drugs they are
Blum pointed out that President Barack Obama’s health care overhaul law is
saving money for beneficiaries with high drug costs, providing a 50 percent
discount on brand-name drugs for those who fall into Medicare’s “doughnut
hole” coverage gap.
The administration is highly sensitive to criticism of its stewardship of
Medicare. After Obama’s health care law cut the program to finance coverage
for the uninsured, many seniors responded by voting for Republicans in the
2010 congressional elections.
Medicare covers about 47 million seniors and disabled people, and about 9 in
10 beneficiaries have some kind of prescription drug plan. Most rely on the
prescription program, also known as Part D, which is delivered through
private insurance plans.
The Avalere study found that copays for preferred brand-name drugs will
increase to an average of $40.60 next year, up from $29.01 currently.
Preferred brands are usually drugs for which the prescription drug plan has
negotiated a discount with the manufacturer.
Copays for non-preferred brand drugs will rise to $91.67 on average, from
$71.52 this year.
Beneficiaries will also pay a bigger share of the cost of specialty drugs,
which can exceed $1,000 or more per prescription. The share for 2012
averages about 32 percent, up from 27 percent this year. Specialty drugs
include many of the newer treatments for chronic diseases such as rheumatoid
arthritis and multiple sclerosis, as well as next generation anti-cancer
drugs that come as pills.
By contrast, copays for preferred generics will remain stable, averaging
$3.79. And copays for non-preferred generics will drop to $9.90, a 43
percent reduction from the current $17.29.
Medicare prescription plans usually have several levels of coverage — each
with a different level of cost-sharing for the patient. The most common kind
of plan has five levels: preferred generics, non-preferred generics,
preferred brands, non-preferred brands and specialty drugs.
Since the Avalere figures are averages for the entire program, actual costs
could vary markedly by medication, plan and region of the country.
The study also found big differences in the total number of drugs covered by
the top 10 plans. Topping the list is the Humana Enhanced plan, which will
cover nearly 80 percent of the more than 2,300 Medicare drugs. By
comparison, the WellCare Classic plan will cover just under half.