Prescription Drugs - Medicine & Money
The truth about prescription drug costs.
Medicare Part D
- The Donut Hole
- Lower "Rebates" Increasing Prices
- Bait and Switch
- Seniors Paying the Tab
- What is Your Plan Paying
- Doctors, Pharmacies & Medicare
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[click here]Medicare Part D Donut Hole
The dreaded donut hole!
Behind every Medicare Part D insurance plan is a pharmacy benefit manager (PBM). While pharmacy benefit managers tout the savings they achieve for individuals plan enrollees, they sometimes steer people away from less expensive generic drugs and toward more expensive brand name drugs. And cost is the only reason, not a decision based on a physician’s therapeutic prescription.
Pharmacy benefit managers negotiate with pharmaceutical manufacturers for “deals” on drugs. All too often this means higher priced brand name drugs are thrown in the mix. The PBM earns “rebates” on all drugs they agree to purchase from manufacturers.
The result is the increased costs throw unsuspecting Medicare patients down the donut hole sooner than necessary.
And those “rebates”? A lack of transparency means you, the Medicare patient, never knows the real profit earned by the PBM and/or the health plan. You never know whether you’ve paid the best price for your medicine. In fact, this year, 2007, beneficiaries likely will be kicked down that hole much faster because drug manufacturer "rebates" are lower this year. That means Part D plans will increase drug and premium prices to you.
Another unknown is whether the PBM will change its formulary (list of approved drugs) in the middle of a plan year. All you can do is hope for the best. Or better yet—hope Congress permits negotiating for the best prices in Medicare Part D as it does in the Veterans Administration system.