The Challenges Of Prescription Pricing For Seniors In The U.S.
President/CEO at Healthcare Solutions Direct, LLC, a nationwide insurance agency focused primarily on the retiree health market.
Whether paying full price or using a Medicare prescription plan, many seniors are living with a medical condition that requires maintenance medications. This means their monthly budget is forever impacted.
How drug companies price medications then becomes inherently important. However, when it comes to prescription drug prices, things are not always what they seem. Drug manufacturers incorporate a few practices consumers should be aware of when it comes to medications.
Medications that are not widely distributed are referred to as orphan drugs because they are designated for small groups of patients. Drug companies price these high because there is less demand for them. In 2017, the median price of orphan drugs was $140,000 per patient per year. In comparison, ordinary drugs had a median price of $28,000. Without having generic substitutes, these small patient groups must pay high prices for necessary medications.
Product hopping and evergreening are other tactics drug manufacturers use that manipulate a drug’s patent. Evergreening is the practice of increasing the life of a patent. This happens by procuring more protections that will extend the manufacturer’s control over the drug, and it means other drug companies cannot release a less expensive version of the medication.
Product hopping involves extending a drug patent in a different way: by tweaking and rebranding a product that is about to go generic, according to the Coalition for Affordable Prescription Drugs (CAPD). This practice costs consumers and the U.S. healthcare system billions of dollars each year. It also happens more often than you’d think. About 78% of drugs associated with new patents are not drugs new to the market. A 2020 report from Matrix Global Advisors found that extending the patents on five specific drugs could cost the U.S. healthcare system $4.7 billion per year.
Canceling out these types of practices by enabling more generic drugs to enter the market could dramatically lower that expense. It would also make medication more affordable to consumers. However, as long as these tactics continue, drug companies can reduce the availability of generic medications. The problem is this forces up prices on something people already may have in their medicine cabinets.
Even if we did away with questionable practices relating to patents, there is still pay-for-delay. This practice occurs when a brand-name pharmaceutical manufacturer compensates its generic counterpart to hold off releasing the generic version of a medication. This practice is not illegal, but ending it would give Medicare more freedom.
Although this practice in particular has come under fire from a legal standpoint, there are currently no federal laws that prohibit pay-for-delay, according to a 2019 article by KHN and PolitiFact. The only headway made to date came from a ruling in 2013 in which the Supreme Court enabled the Federal Trade Commission (FTC) to challenge pay-for-delay agreements. This move changed the game, but not in the way you might think. The article notes that the ruling led pharmaceutical companies to stop exchanging cash but continue the practice by compensating each other in different ways.
The repercussions of all these practices continue to fall on the patients. According to the FTC, pay-for-delay costs consumers $3.5 billion per year in higher drug prices. This impact is not going unnoticed, either. A 2019 survey found that 23% of seniors taking prescription drugs said it is difficult to afford their medications. This can have a damaging effect on individuals. Those who cannot afford their medications may not always take them as they should. This can lead to worsening conditions and a lower quality of life.
Medicare does help make prescription medication more affordable for seniors through its Extra Help program. And working with an experienced health insurance provider can help you find the prescription coverage to match your needs with your budget. Those who are Medicare eligible can work with a Medicare insurance agent.
As drug prices continue to be a hot topic in this country, the hope is that more substantial positive change will emerge over time. Until drug manufacturers are held accountable for these harmful practices, seniors should focus on finding the best, most affordable Medicare plan for their situation.
The Challenges Of Prescription Pricing For Seniors In The U.S.
Tracking your Medicare account information by registering online should be just as important as getting the coverage itself. Maintaining an online account with Medicare not only gives you a way to store your information, but it also ensures you have easy access to all your information. If you have Medicare, I recommend that you also set up a MyMedicare.gov account.
Once you have enrolled in Medicare and received your unique ID number, make it a priority to create an online account at MyMedicare.gov. You cannot register without your unique ID, so be sure to have it with you when you sit down at your computer.
The registration process is simple, and you’ll have access to all of your Medicare information in a single place once you complete it. That means you won’t have to rely on a Medicare Summary Notice in the mail, and you can alleviate any confusion about what coverage you have. I also recommend checking the website to see whether you have met your Part B deductible for the year and reading through the site’s instructions on how to pay your Medicare premium if it’s not deducted from your Social Security check.
A very popular service associated with the site involves your Medicare ID card itself. Since the card is not laminated, it can go through a lot of wear and tear if you use it regularly for services at doctors’ offices, facilities and hospitals. If this happens to you, I recommend going to the website to print a temporary card and then request to receive a replacement card in the mail. You can also do this if you lose your card.
You can also use your online account to prevent confusion about your insurance plan. It is no secret that Medicare can be confusing. It is made up of so many parts that it is easy to feel uncertain about your coverage. Many times, I talk to a Medicare-eligible client who does not know what type of insurance coverage they have. Before meeting with your insurance agent, I recommend checking the type of coverage you have on the MyMedicare.gov website so your agent can better assist you.
Whether you have Part A, Part B, Part D, a Medigap supplement or a Medicare Advantage plan, you can use your online account to clearly understand what type of coverage you have. I recommend checking your coverage to keep yourself “in the know” about what your benefits cover and so you can easily respond to questions when they come up.
In addition to reviewing your plan information, I also recommend checking your online account to view new medical claims. Make sure to check what Medicare has approved and what they paid for each bill. You should also review how each claim impacts your deductible and whether you have reached it for the calendar year.
You should also review the list of the prescriptions you’ve filled throughout the year on the website. Use this list as a reference for what you are currently taking and what medications you need to refill. If your list is long, show MyMedicare.gov’s list to your medical professionals during your visits to save yourself a lot of time and energy when you have appointments.
You can also use the website to track the preventative care that you are eligible for on a month-to-month basis. Use this information to inform discussions with your doctor about which services you need and give yourself a head start on coordinating everything.
Other features of your online account that will help make it easier to manage your Medicare plan include the ability to pay your bills online or verify that your payments are being automatically deducted from your Social Security payment. I recommend that you also keep a list of your favorite doctors on the website so you do not have to go searching for names, addresses and phone numbers every time you need to see a specialist.
Perhaps the best part of having an online Medicare account is that you are giving yourself the ability to easily stay on top of your own healthcare coverage. This is not always easy, especially for individuals who recently left a job that provided health insurance. There are often far fewer options in that environment than with Medicare, and coverage is often packaged within a very specific plan. Medicare is different because it offers many different options. You really have a lot more moving parts to consider when you’re crafting a Medicare plan that works for your specific health needs.
As you can see, there are a lot of ways you can utilize a MyMedicare.gov account. You can use it to easily access your medical information, and I also recommend using it to regularly review your coverage and claims so you can react more quickly when something seems out of place. If you see any issues or gaps in coverage that you would like to discuss, the best thing to do is connect with your insurance agent. By taking these steps, you can better position yourself to discuss everything about your current situation and see if you need help modifying your coverage to better fit your needs.