Medicare Cancer Drugs Are Costly

Medicare cancer drugs are about to become more costly because of proposed changes in the way they are covered. CMS wants to “save money” by moving Part B drugs to Part D. GA Medicare expert Bob Vineyard breaks it down for you.

Medicare cancer drugs
Medicare Cancer Drugs Becoming More Expensive

Not only cancer drugs, but medications for rheumatoid arthritis, macular degeneration and osteoporosis. DME drugs such as insulin may become ineligible for Medicare Part B reimbursement.

Medicare Cancer Drugs Becoming More Expensive

Saving Medicare – Sort of . . .

Medicare Advantage plans are now able to make changes in the way expensive, injectable drugs are covered. Drugs administered in a clinical setting will be subject to scrutiny.

Medicare Advantage plans will be REQUIRED to try cheaper drugs which may not be as effective as cancer drugs administered in a clinical setting.

These Advantage plans will be encouraged to employ step therapy to “reduce costs and improve outcome”.

Reducing costs means saving money spent by Medicare and the insurance carrier.

Not saving YOU money.

Note, this is only a test. Using Medicare Advantage patients as guinea pigs to see if lower cost drugs result in similar outcomes as more expensive protocols. Do you really want to be a test model?

If the test works cancer drugs will be shifted away from Part B coverage to Part D. This means you, the patient, will pay MORE for your medication.

Treating Cancer is Expensive

Years ago most treatment involved extensive surgery, radiation and chemo. Most of the treatment was as a hospital inpatient.

Now cancer, like most other medical conditions, is treated on an outpatient basis.

If you have original Medicare and a supplement plan your out of pocket costs are minimal. Often less than $500 per year for health care.

Drugs are a different story . . . unless you are receiving treatment under Medicare Part B.

Also, outpatient self administered drugs are subject to copay’s or coinsurance. It doesn’t matter if you have an Advantage plan or stand alone PDP. Your cost is the same.

Cancer forces 42% of patients to exhaust life savings in 2 years. The average patient saw a loss of $92,098. Bankruptcy occurred in 38.2 percent after four or more years. – Becker Hospital Review

Finding and Choosing the Right Plan

Turning 65 many get confused about the various health insurance options. Some ask friends or relatives. Others attend seminars. And there is all the mail that arrives every day before you are Medicare eligible.

Part D is the most confusing component of Medicare.

If you or a family member have experienced cancer you know about the cost of prescription drugs.

You need help, but not from just anyone. Consider talking with an expert. A GA Medicare expert . . .

Give me 10 minutes by phone to answer your questions. Ask me anything about Medicare. Anything at all.

Either you like what you hear or you don’t. If you don’t feel I can help you then we part as friends. No hard feelings. It’s not personal, just business.

But if you want and need my help I am ready to guide you through the Medicare maze. We move forward at your pace, not mine.

All I ask is an opportunity to EARN your business.

When you allow me to be your agent you have unfettered access any time. Call or email.

And there is never any charge.

This is my offer you can’t refuse.

What is the Pharmacy Gag Rule?

What is the pharmacy gag rule and why should I care? Is it because the medicine has a bad taste? Does the gag rule affect my Medicare Part D coverage? GA Medicare expert Bob Vineyard answers your questions.

pharmacy gag rule
What is the Pharmacy Gag Rule?

The pharmacy gag rule existed in a handful of states prior to October, 2018. It works like this.

You take a prescription to your pharmacy. If you ask the druggist about a lower price he/she was prohibited from telling you how to save money where the gag rule was in place.

The result, you pay more for your medication when you use insurance.

What is the Pharmacy Gag Rule?

How Does the Gag Rule Affect Me?

Essentially you pay more for your drugs than you should.

A recent study by JAMA indicates people with Medicare Part D drug insurance overpaid for prescriptions by $135 million in 2013. Copayments in those plans were higher than the cash price for nearly 1 in 4 drugs purchased in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33 percent.KHN

That’s more than just sofa change. Seniors on a fixed income need to hang on to as much of their money as possible.

Some folks, like Steve Knievel, considers $135 million “falling short of where it needs to be”

As a nation we spend $450 million on prescription medications. I think cutting costs by 25% to be significant.

Good News – Bad News

First the good news.

People on Medicare can see the impact of the pharmacy gag rule next year. As of January 1, 2020 a senior on Medicare is entitled to know if they can get their drugs for less by paying cash.

Pharmacists are allowed to tell you how to save money without using your Part D card.

Now the bad news.

Just because a druggist CAN tell you about lower prices does not mean they WILL tell you.

If you want to save money you will have to ask . . .

You can also save money by checking out Free and Low Cost Prescription Drugs.

But if You Like Paying Too Much . . .

You can always use your Part D plan.

GA Medicare expert Bob Vineyard has over 500 clients in Georgia. He specializes in explaining how to save money on prescription medications.

There is no pharmacy gag rule that can keep him quiet.

Georgia Medicare Plans YouTube Channel has several videos explaining how Medicare Part D works. Here are just a few things you can learn.

  • Choose a Part D plan that has a deductible
  • Use preferred pharmacy’s
  • Ask your doctor about generic alternatives
  • Pay cash for generic drugs
  • Use a discount card like GoodRx for generics
  • Consider buying brand names by mail from Canada

Every year we review our clients current drug plan and compare it to the new plans for the following year. Almost every time our clients will save money. An average of $60 per month.

Two years ago we saved one client over $600 per month and another over $700 per month.

A few weeks ago we showed a client how to cut his prescription eye medications from $800 to less than $250.

Let’s face it. Medicare Part D is confusing. But it doesn’t have to be.

How much can you save?

The pharmacy gag rule never kept us from telling our Medicare supplement clients how to save money.

Medicare Part D is Confusing

Medicare Part D is confusing to me. Why is that? What makes it so hard to understand? What is the donut hole? I thought it was going away. What’s wrong with picking the plan with the lowest premium . . . as long as it doesn’t have a deductible? And why do some plans have a deductible? How does it work? Do I pay the deductible BEFORE I have copay’s?

Medicare Part D is Confusing

Can anyone explain how Medicare drug plans work?

GA Medicare expert Bob Vineyard can help.

Why is Part D so Confusing?

Why is Medicare Part D so confusing. The Medicare drug coverage is designed by folks in Congress who will never use the plan. Part D is administered by insurance carriers.

What could possibly go wrong?

When you search for the phrase “Medicare Part D confusing” there are 107 million results. Congratulations! You are not the only one who is confused by Medicare drug plans.

Medicare Part D is Confusing

What if I Can’t Afford My Drugs?

Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs. If you have limited resources and income you may be able to get Extra Help. Monthly premiums, annual deductibles, and prescription co-payments — related to a Medicare prescription drug plan.

To qualify for Extra Help you must meet the resources and income requirement. You must also live in the United States.

In some cases you might qualify for a PAP (Patient Assistance Program).

Yes, Medicare Part D is confusing but there is plenty of help. You just need to know who to ask. Consider the folks at Georgia Cares as an example.

Medicare Late Enrollment Penalties

Did you know you can be penalized for failure to enroll in a Medicare drug plan on a timely basis?

The late enrollment penalty is an amount added to your Medicare Part D monthly premium.

You may owe a late enrollment penalty if you lack creditable coverage for 63 days or more after your Initial Enrollment Period is over, you go without:

  • Creditable drug coverage
  • Medicare Part D plan
  • Medicare Advantage plan that includes drug coverage
  • Other coverage such as employer group health plan

Also the LEP depends on how long you went without creditable coverage.

Your penalty is determined by multiplying 1% of the “national base beneficiary premium” ($33.19 in 2019) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

The penalty you will pay is based on a formula so it could increase from year to year. It is also payable for life.

Medicare Part D is confusing. GA Medicare expert Bob Vineyard can help.

Part D Deductible

The majority of Medicare drug plans include a deductible. In most cases the deductible applies to tier 3 or higher drugs. The deductible can also be avoided by using mail order or filling your med’s at a preferred pharmacy.

Most people do not understand how the deductible works so they focus on plans without a deductible.

Many agents also do the same. Rather than explaining how a Part D deductible works they only sell plans without a deductible.

In most cases no deductible plans have higher premiums AND higher copay’s.

If you want to learn more about Medicare Part D plan deductibles, this video will help.

Using the Medicare Drug Plan Finder

Why is Medicare Part D confusing? If it was easy you wouldn’t need me.

Pick a Drug Plan

Pick a drug plan, Medicare 101. Finding the RIGHT Part D plan is the most challenging part of Medicare. Experienced agents often get it wrong.

Medicare 101 - Picking a drug plan

Medicare Part D has a lot of moving parts. Formulary’s. Deductibles. Copay’s. Coinsurance. Preferred pharmacy’s. Brand name drugs. Generics. Which drugs are less expensive if you pay CASH.

It usually takes me anywhere from 5 to 20 minutes to run a drug report. Add another 10 to 30 minutes to explain to my Medigap client how to properly use the plan.

Very few people, including agents, understand drug plan deductibles.

Choosing Part D Isn’t Easy

Many think choosing a Part D plan is simple. Look for the plan that does not have a deductible and pick the one with the lowest premium.

That is the WRONG way to pick a drug plan . . . unless you enjoy OVERPAYING for your drug coverage.

Whether you pick a drug plan or you allow someone to help , at least make sure you get it right.

Do you want to DIY? Here is where you start.

Let me know how this works for you.

I have been running Medicare drug plan reports since 2010. The first few years I had no idea what I was doing. I made mistakes but fortunately they weren’t costly.

Showing clients how their copay changed once the plan deductible was satisfied was impossible. A few years ago Medicare reworked their software so now they can see month to month how their OOP changes.

When you use these new reports it is very obvious why a deductible plan produces lower OOP costs.

Why is Medicare Part D so Confusing?

Seniors often buy the wrong drug plan and spend too much on their prescription plan. Seniors on Medicare spend an average of $263 per month on prescription medications.

Lower your medication bill by only using your drug card when necessary. The right drug plan will save a lot on brand names but you will almost always pay MORE for generics.

Consider paying cash or using GoodRx instead for maximum savings. Also pick a drug plan that has a deductible.

This report compares a $17 plan with a deductible vs a $79 plan with no deductible. Not only is the premium for the no deductible plan considerably higher but so are the copay’s.

This is not an aberration. No deductible drug plans are more difficult to find. Also the premiums AND copay’s are noticeably higher than plans with a deductible.

Why not let my Pharmacist Help me Pick a Plan?

Your druggist probably has no idea how to run a Medicare drug plan report. Even if they do know how, they will not have the time. He or she will simply recommend a plan they see most often.

That means you may not know how much you could have saved compared to the other 2019 Medicare Part D plans.

Have you bought something recommended by a friend then later discovered you PAID TOO MUCH?

Sometimes you can return the item for a refund.

Medicare drug plans don’t work that way.

Your copay can range dramatically from one plan to the next. Copay’s are even further impacted by using the wrong pharmacy.

Last year I ran a report for a client. Had he kept his existing plan and pharmacy his total annual out of pocket (premiums + copay’s) would have been $13,000. By switching plans AND pharmacy’s he cut his OOP to $6,000.

You Can Pick Your Own Drug Plan

Some folks don’t want help with Part D. They have done it for their parents or other relatives. The plan they found worked so no need to make a change.

As one who runs hundreds of Medicare Part D reports every year I can tell you this. Picking a drug plan is not easy.

Sometimes I will run the report several times to find the lowest possible combination of premiums and copay’s.

Most folks who take the DIY approach only run the report once.

I tell my clients to run their own report, then let me generate a report. Almost without exception my total out of pocket is less.

This is all about saving money by picking the best drug plan. And that is the way it should be.

Am I Required to Buy a Medicare Drug Plan?

Am I required to buy a Medicare drug plan? What if I don’t take drugs? Can I wait until I need a plan? GA Medicare expert Bob Vineyard explains.

Is Medicare Part D required by law? What is the best 2019 drug plan? Is there a penalty if I DON’T buy a prescription plan? Is Part D optional?

required to buy medicare drug plan
Required to Buy a Medicare Drug Plan?

Medicare Part D

I don’t take any prescription drugs. Why must I buy something I don’t need or want?

You are not REQUIRED to buy a prescription Medicare drug plan. But if you don’t enroll in a plan when first eligible you will pay a penalty.

And the penalty is payable for life. It also increases every year.

So . . .

Am I Required to Buy a Medicare Drug Plan?

Where Can I Find the BEST Plan?

Finding the best Medicare drug plan isn’t easy. Part D is the most confusing part of Medicare. How do I find the RIGHT plan for me?

You could get lucky this time, but what about next year?

Is there a GUIDE to Medicare Prescription Drug Coverage? Yes, and it is only 88 pages . . .

The best drug plan is the one that is right for you. Do the following before enrolling.

  • Use the Medicare Drug Plan Finder
  • Enter all your current medications
  • Choose a pharmacy. Look for the one with the lowest copay’s.
  • Make sure all your drugs are on the formulary
  • Consider buying generics with cash or a discount card
  • Look for plans with a deductible
  • Enroll in a plan with the lowest total out of pocket cost

You can do all this by yourself.

Or you can ask a Medicare expert to help. I am always willing to help my Medigap clients. If you are not a client, please don’t ask. It’s not personal, it’s just business.

Why is Medicare Confusing?

Seniors often buy the wrong drug plan and spend too much on their prescription plan. Seniors on Medicare spend an average of $263 per month on prescription medications.

Lower your medication bill by only using your drug card when necessary. The right drug plan will save a lot on brand names but you will almost always pay MORE for generics.

Consider paying cash or using GoodRx instead for maximum savings. Also look for a Medicare drug plan with a deductible. https://youtu.be/LaA9NnFeBXI

You have questions? I have answers. Call or email.

#MedicareDrugPlan #MedicarePartD #GAMedicareExpert