David Belk, M.D.
The question I’m addressing today is: How much help can you expect to get from your Part D plan when you use it to buy prescription drugs?
Hello again everyone! I hope you all enjoyed your Thanksgiving.
Most Medicare recipients know that private insurance companies offer prescription drug coverage to Medicare beneficiaries in the form of Part D plans. If you have Medicare, you’ve also probably been told that you’ll be fined if you delay buying into a Part D plan once you qualify for Medicare. (Though you probably weren’t told how much that fine is– about $4 a month extra for each year you delay.)
The question I’m addressing today is: How much help can you expect to get from your Part D plan when you use it to buy prescription drugs?
To help answer this question, I use the case of a patient of mine who got a liver transplant last year for liver cancer. She has Medicare and a Part D plan (SilverScript). I think most people are aware of the fact that liver transplants are quite complicated, so it shouldn’t surprise anyone that she was prescribed a lot of medications last year.
To assess how much “help” she got buying all of her prescription drugs, I itemized every prescription she filled last year, how much she paid (in copays) for each prescription, how much her plan paid for each prescription, how much the pharmacy paid for the pills or capsules she bought each month and, finally, what her cash price might have been if she had no coverage for these medications.
Now, when going over all of these prices, it’s important to note that she also paid about $35 of month in premiums for her Part D coverage– or $420 that year in addition to her copays.
So how much did her Part D plan “help” her in purchasing all of her prescriptions last year? Not much or, rather, not at all!
21 of the medications she was prescribed last year were inexpensive generic medications. Her insurance paid exactly nothing for eight of those medications and less than half what she paid for the remaining 13 of those 21 medications. In total, her insurance paid less than $110 for all 21 of those medications last year whereas she paid more than $250. The cost to the pharmacy for all 21 of those medications was only $212, so her copays actually covered more than what the pharmacy paid.
However, my patient did need one rather expensive medication last year. Nearly all transplant patients are prescribed an anti-viral medication called valganciclovir to protect them from a life-threatening disease called cytomegalovirus.
So here is the most important question regarding this case: How much did my patient’s insurance help her in purchasing the one really expensive medication she needed last year?
The answer: Not at all!
Her copays for just that one medication exceeded $1,200 for both July and August. In September, she came to my office for an appointment and, after telling me how much that one medication cost her, I went online to show her that she could buy a month’s supply for $840 at her local Costco!
So, the one time this person needed her insurance, they cut out on her and left her hanging. This is what I usually find with most of the Part D plans my patients have– they pretend to help seniors buy prescription drugs that really don’t cost very much then cut out whenever someone needs an expensive medication.
There are exceptions, of course– plans that actually offer good prescription drug coverage. But the majority of Part D plans my patients have are just like this SilverScript plan: junk insurance!
Anyway, here is the new webpage with all of the details:
https://truecostofhealthcare.org/part-d-case-study/
P.S. I’ll be sending you another email soon that deals with the total cost of this liver transplant, start to finish, so stay tuned.
David Belk MD
Internal Medicine
http://truecostofhealthcare.org
