Higher Copays Seen for Medicare Brand-Name Drugs

Higher copays seen for Medicare brand-name drugsWASHINGTON (AP) - With three weeks left for seniors to change their Medicare prescription plan for 2012, a study released Wednesday finds that copays for brand-name drugs are going up - sharply in some cases.

Copays for preferred brand-name drugs will increase by 40 percent on average next year, and non-preferred brands will average nearly 30 percent more, according to the study by Avalere Health. Copays are the portion of the cost of each prescription that the customer pays the pharmacy.

The report underscores how important it is for Medicare beneficiaries to check their prescription coverage before open enrollment ends Dec. 7.

Medicare announced this summer that premiums for prescription plans would remain unchanged next year, an average of about $30 a month. But the plan with the lowest monthly premium may not always be the best deal.

"Seniors need to look beyond the premium to understand their drug benefit," said Avalere CEO Dan Mendelson. "The more the cost burden gets shifted onto the patient who needs the medication, the more important it is for seniors to understand that next level." Avalare is a data analysis firm serving the health care industry and government.

Medicare officials said they were reviewing the study. Pointing to stable monthly premiums and improved benefits, spokesman Brian Cook said the prescription program is getting stronger.

Mendelson said Avalere's findings show that Medicare prescription plans are steadily shifting costs to patients who need more expensive kinds of medications, while trying to keep costs in check for those whose conditions can be managed with less-expensive generics.

The costly medications include brands and so-called "specialty" drugs for diseases such as multiple sclerosis, cancer and rheumatoid arthritis. By contrast, Avalere found that copays for generic drugs will remain stable or decline.

Medicare covers about 47 million seniors and disabled people, and about 9 in 10 beneficiaries have some kind of prescription drug plan. Most rely on the prescription program, also known as Part D, which is delivered through private insurance plans.

The Avalere study found that copays for preferred brand name drugs will increase to an average of $40.60 next year, up from $29.01 currently. Preferred brands are usually drugs for which the prescription drug plan has negotiated a discount with the manufacturer.

Copays for non-preferred brand drugs will rise to $91.67 on average, from $71.52 this year.
Beneficiaries will also pay a bigger share of the cost of specialty drugs, which can exceed $1,000 or more per prescription. The share for 2012 averages about 32 percent, up from 27 percent this year.

By contrast copays for preferred generics will remain stable, averaging $3.79. And copays for non-preferred generics will drop to $9.90, a 43 percent reduction from the current $17.29.

Medicare prescription plans usually have several levels of coverage - each with a different level of cost-sharing for the patient. The most common kind of plan has five levels: preferred generics, non-preferred generics, preferred brands, non-preferred brands, and specialty drugs.

Since the Avalere figures are averages for the entire program, actual costs could vary markedly by medication, plan and region of the country.

The study also found big differences in the total number of drugs covered by the top 10 plans. Topping the list is the Humana Enhanced plan, which will cover nearly 80 percent of the more than 2,300 Medicare drugs. By comparison, the WellCare Classic plan will cover just under half.

Copyright 2011 The Associated Press.

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you can see now how big business is controlling congress and getting their higher prices.start looking at your congressmen and senators and see if they are getting paid by these big bussiness,s.if they are just vote them out and unemploy them like they have done to this country.remember they work for you and they can be fired by you the people.and then remind the new elected officals they work for you the people.ever think how drugs are cheaper in mexico because the government of mexico does not let them raise prices like they do here in the usa.

November 18 2011 at 6:50 AM Report abuse rate up rate down Reply

What a bunch of crap!!!! Worked all of our lives and now have to deal with the idea that you can't afford your medications. We are not on welfare at all and have paid our own way always. I for one am tired of the Insurance
Companies taking advantage of everyone.

We have our funeral arrangements paid for so guess it would be a lot cheap to say to hell with it all.

November 18 2011 at 12:35 AM Report abuse +1 rate up rate down Reply

I feel bad for the people who have to take medicine everday to sustain life. The prices of the drugs are going up and the co-pays are getting higher. SO what good is it anyway? We as a country seem to have such little respect for our elderly.

November 17 2011 at 9:36 PM Report abuse +4 rate up rate down Reply

I don't know where they got there info from but as of most of the time it is wrong again. 2011 premium for part D is $51.40 in 2012 $58.70 plus there is a $150 deductibal duebefore they start paying. and they are charging us more for the copay. most people will not be able to get the scripts we are on fixed incomes howare we to pay the $150 deductible.

November 17 2011 at 8:31 PM Report abuse rate up rate down Reply
2 replies to JON's comment

The cost depends on which Medicare Part D plan you are enrolled in. Mine is $14.80/mo, going to to a little over $15.00/mo next year. Same with the deductibles/co-pays.

November 18 2011 at 4:02 AM Report abuse +1 rate up rate down Reply

So I should just not even be covered - my RX is 40% discount at Sam's club. I pay $21 and the price at CVS and Walgreens is closer to $100. The drug companies and the insurance companies have no interest in people - only money.

November 18 2011 at 4:30 AM Report abuse +1 rate up rate down Reply

Why does the Federal Government allow this?

November 17 2011 at 8:16 PM Report abuse +4 rate up rate down Reply
1 reply to R's comment

The federal government is IN CHARGE of it!

Just wait until obamacare is fully activated. This is only the beginning.

November 18 2011 at 12:53 AM Report abuse -1 rate up rate down Reply
1 reply to pete's comment

Pete, the prices are set by the Medicare Part D insurance you have. That is through private companies, not the Federal Government.

November 18 2011 at 4:03 AM Report abuse +1 rate up rate down

oh what a shocker

November 17 2011 at 8:11 PM Report abuse rate up rate down Reply

When will you people learn not to depend on the Government from cradle to grave and start thinking for yourself , YOU are the Government you tell YOUR Reps what you want and tell them to get their ass in gear and make things happen or join the unemployment line .

November 17 2011 at 8:00 PM Report abuse -1 rate up rate down Reply

My generic copay has of Jan 1st will go up 60% on part d medi care thanks very much U.S Goverment. After two years with out a cola, we get a 3.6% raise and food is already up 3.9% I love the way this country is run.

November 17 2011 at 7:30 PM Report abuse +2 rate up rate down Reply
1 reply to MiCkEyY's comment

It depends on the company you use. Mine is going up less than 5%.

November 18 2011 at 4:05 AM Report abuse +1 rate up rate down Reply
Jack or Lorraine

Of course, my saying is Another day, the goverment has so many loop holes, NOTHING IS FREE give a little and take a lot, soon the peeople getting SS wont have any, the rich get richer and there is no poor anymore, JED

November 17 2011 at 7:28 PM Report abuse +1 rate up rate down Reply

I look for euthanasia to be on the list of benefits before too much longer.

November 17 2011 at 6:08 PM Report abuse +5 rate up rate down Reply