Medicare Patients Unaware of Real Drug Costs

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NEW YORK (MainStreet) -- A medical consulting firm is out with new numbers on prescription drug prices for older Americans, and the findings may surprise Medicare beneficiaries who don’t realize the out-of-pocket costs they’re paying for higher-end prescription drugs.

So what’s up with that? Older Americans may have been lulled into a false sense of security, as prices for most prescription drugs have held steady, and should remain so in 2012.

According to the U.S. Department of Health and Human Services, Medicare average prescription drug prices will not rise in 2012 – and that’s certainly good news for Medicare beneficiaries. The agency says that about 900,000 Medicare recipients are receiving up to 50% discounts on brand-name prescription drugs and have experienced increased availability of generic drugs so far in 2011.

But even with the discounts, seniors would do well to sit up, take notice, and start really examining the price they pay for prescription drugs - particularly those drugs placed on “specialty tiers” by their healthcare plans.

A new study out by New York-based NERA Economic Consulting says that seniors are “largely unaware” of the high price tags linked to prescription drugs. The study took a long look at Medicare Part D members’ awareness of the out-of-pocket costs of drugs on those tiers. NERA defines “specialty tiers” as a unique Medicare prescription drug category “that includes higher-cost, brand-name medications and often include medications used to treat conditions like cancer, multiple sclerosis, rheumatoid arthritis, HIV/AIDS and lupus.”

NERA rolled out the following results from its study, which surveyed 683 Americans 65 and older:

  • Many survey respondents were unaware that Part D insurance plans charge differently for expensive medicines used to treat complex, chronic diseases. Half of the survey respondents mistakenly believed their plan would require them to pay a co-pay rather than coinsurance for a drug on the specialty tier.
  • Respondents also underestimated the amounts they would have to pay out of pocket for specialty-tier drugs, including those used to treat rheumatoid arthritis and multiple sclerosis.
  • The findings suggest that most Medicare beneficiaries are unlikely to anticipate the financial impact of being prescribed a drug on a specialty tier.

NERA concludes that in most cases, seniors just aren’t sure how much they’re paying for what, in many cases, are higher-priced prescription drugs – but drugs they may well need. Even worse, in most instances, Medicare recipients underestimate how much they have to pay for those prescription drugs.

What steps should you take? Medicare consumers on such specialty tiers should be in direct consultation with their doctors before paying for any prescription drugs. Also, contact your insurance provider – or Medicare directly – for good, solid, accurate prescription drug information.

In tough budgetary times, there’s no sense paying more for high-cost prescription drugs. In that case, knowledge really is power.

—For more on Medicare, visit MainStreet’s “Health Care” topic page for our latest coverage!

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