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It pays – really pays – for seniors to review their Medicare drug coverage.
By Rose Hoban
The Thanksgiving holiday has a number of traditions: turkey, pies, football and, for the past decade, helping elderly parents or grandparents with their Medicare Part D drug plans. The holiday comes at the end of the annual sign-up period, when seniors take the time to review their plans for the coming year and save hundreds by making adjustments. Or not.
“Medicare beneficiaries should really review their coverage every year,” said Gina Upchurch, head of Senior PharmaAssist, an organization dedicated to helping Durham County seniors understand and get access to the appropriate drugs. In 2012, Upchurch did some research: She and her co-authors found that about two-thirds of seniors could save more than $530 annually by checking their Medicare drug plans during the open enrollment period each fall. She said that this past year they surveyed 683 beneficiaries who came in for help choosing their Medicaid drug plans. Two-thirds needed to switch. “Every year, it’s two-thirds!” Upchurch said. “Two-thirds need to switch plans for a mean annual savings of $983.” [pullquote_left]There are counselors who work with the Senior Health Insurance Information Program in each county. Find one here. Or call 855-408-1212[/pullquote_left]But the research shows fewer than 15 percent actually make the switch, she said. That frustrates Upchurch, who has spent the last decade getting to know the Medicare drug benefit, which rolled out in 2006 “Overall, 75 percent of seniors are not in their lowest-cost plan,” she said. “On average, beneficiaries are spending 30 percent more than they have to on their medicines.”
When Congress created the Medicare Part D in 2003, elected officials said they wanted to give seniors more choice over their plans. But for years, Upchurch has said she believes the program has “too much choice.”
“They need to remove some of the moving parts to Medicare Part D to standardize it,” she told a roomful of pharmacists during a training in October. “It’s way too overwhelming and you get what’s called decision-making paralysis.” Many seniors have one or a handful of really expensive drugs, and the trick is to find the pharmacies selling those medications at the cheapest price. Upchurch said that can be harder than you think. “One drug might be cheaper at one pharmacy and one might be cheaper at another pharmacy,” said Durham resident Maribeth Hersey, whose husband had several expensive drugs. “I don’t understand it.” Hersey told of going to pick up a blood-thinning medication for her husband. “When it was advertised, the wrong price was in the system, or the price changed, I don’t know,” she said. “Because the computer said $45 a month [and] when I went to pick it up it was $720. So I went across the street to Walmart, where it was $396 a month.” It subsequently went up to $1,200 a month. “I don’t think it needs to be this hard,” Hersey said. This year, she spent days on the computer comparing drug plans, printing them out and hanging them up in the kitchen, combing through each option. “I’m not working, so it’s my full-time job, and it’s not so bad right now, because I have the time to do all the research,” Hersey said. “But for people who have a low reading level or they’re seniors … things are more intimidating. I don’t know how they do it.”
Sometimes there’s no way around the prices seniors pay for medications; they’re just expensive. That’s what Raleigh resident Pat Stumpf found when she went shopping for her husband’s Namenda. The drug, which is used to relieve some of the symptoms of Alzheimer’s, was a blockbuster for the manufacturer Activis, netting the company $1.5 billion in sales in 2013-14. It cost Stumpf and her husband a pretty penny. “Insurance companies put it at top-tier level,” she said. “I had to start paying a $120 copay every month.”
The free market takes, and it gives
Upchurch explained that the Centers for Medicare and Medicaid Services instructs insurance companies to cover drugs for all kinds of conditions and to have at least one or two of every type of drug in their drug lists, called formularies.