Rising Rx premiums could hit seniors

12/8/2008

WASHINGTON —Health experts are warning that many Medicare beneficiaries will pay more—perhaps a lot more—for the prescription drugs they obtain through the Medicare Part D drug benefit program in 2009, as the privately run prescription drug plans that administer the program jack up premiums and prescription co-pays. And that expected jump in out-of-pocket costs could disrupt lower-income seniors and force them to make changes in their coverage plan to take full advantage of the federal drug benefit, an advocacy group warned Nov. 18.

The re-enrollment period for the 2009 Medicare drug benefit program is set to expire Dec. 31, and many seniors and caregivers are scrambling to sort through the various prescription plan options in Part D as they try to decide whether to stay with the plan they use now or switch to another. Scrambling the picture, however, is the near-certainty of rising out-of-pocket costs and, perhaps, a squeeze on some benefits.

The picture could be even harder to sort out for Americans at the lowest end of the economic spectrum, one seniors organization warned. More than 2 million Medicare beneficiaries may once again “face a disruption to their prescription drug coverage,” according to a report issued last month by the National Senior Citizens Law Center.

“Skyrocketing premium costs and a dramatic reduction in plans available will require [beneficiaries] to switch to new Medicare Part D plans to avoid new costs,” the group added.

The NSCLC isn’t alone in warning of dramatic increases in the costs seniors will incur next year for their participation in PartD. Avalere Health, a Washington-based policy and healthcare consulting group, also foresees a shifting Medicare drug coverage landscape.

“There are sizable changes in Medicare Part D for 2009, as health plans further calibrate their offerings to achieve profitability,” Avalere noted. “Aggressive spikes in average monthly premiums will test consumers’ ’loyalty in a year where beneficiaries may have no tolerance for absorbing additional out-of-pocket costs.”

According to NSCLC, changes to the 2009 Part D plans will force low-income beneficiaries “to switch to new plans or face premiums that they cannot afford.” It could also limit access to the medicines prescribed by those patients’ doctors, according to the report.

“The Low Income Subsidy program provides total or partial premium assistance to over 9 million low-income seniors and individuals with disabilities,” noted the group. “These Medicare beneficiaries only receive the full benefit of the subsidy if they enroll in plans with premiums below an amount set yearly by Medicare.

“Because Medicare Part D benefits are administered through private insurance companies, premium costs change from year to year and so do the plans that are fully covered by the subsidy,” added NSCLC.

“Everyone who receives premium assistance from Medicare for their Part D benefit should make sure that the subsidy will continue to cover their plan premiums and that their plan will continue to cover their prescriptions,” said Kevin Prindiville, staff attorney for the organization.

Chrissy Kopple, spokes-person for the National Association of Chain Drug Stores, said community pharmacists can help older Americans sort through the implications of rising Part D costs. “Each year, many Medicare beneficiaries eligible for the Low Income Subsidy are reassigned to a new Medicare plan,” noted NACDS in a statement prepared for Drug Store News. “Pharmacists know first hand that this can be a difficult transition period as many LIS beneficiaries go to their local pharmacy with questions about their plan, and whether or not they can still obtain their prescription drugs and services from their pharmacy of choice.

“NACDS believes that CMS should continue to reassign LIS beneficiaries to plans that would not require a co-payment,” the group noted. “We encourage CMS to work with patients and patient advocacy groups to ensure that notices sent to beneficiaries regarding their LIS status is read and understood by beneficiaries. CMS should continue to ensure that all reassignments of LIS beneficiaries are completed in a timely fashion and ensure system readiness before Jan. 1.”

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