Tag: drug price transparency

Medicare Surprise: Drug Plan Prices Touted During Open Enrollment Can Rise Within a Month

By Susan Jaffe  | Kaiser Health News | May 3, 2022 | This KHN story also ran on

Something strange happened between the time Linda Griffith signed up for a new Medicare prescription drug plan during last fall’s enrollment period and when she tried to fill her first prescription in January.

She picked a Humana drug plan for its low prices, with help from her longtime insurance agent and Medicare’s Plan Finder, an online pricing tool for comparing a dizzying array of options. But instead of the $70.09 she expected to pay for her dextroamphetamine, used to treat attention-deficit/hyperactivity disorder, her pharmacist told her she owed $275.90.

“I didn’t pick it up because I thought something as wrong,” said Griffith, 73, a retired construction company accountant who lives in the Northern California town of Weaverville.  “To me, when you purchase a plan, you have an implied contract,” she said. “I say I will pay the premium on time for this plan. And they’re going to make sure I get the drug for a certain amount.”

But it often doesn’t work that way.  [Full story in Kaiser Health News, NPR  and Tampa Bay Times]  

 

 

…

Looking For Lower Medicare Drug Costs? Ask Your Pharmacist For The Cash Price.

Sometimes a drug plan’s copay is higher than the cash, but insurers’ “gag orders” keep pharmacists from telling Medicare beneficiaries. A little-known Medicare rule requires pharmacists to divulge the lower cash price if patients ask.

By Susan Jaffe  | Kaiser Health News | May 30, 2018 | This KHN story also ran on 

As part of President Donald Trump’s blueprint to bring down prescription costs, Medicare officials have warned insurers that “gag orders” 

Scott Olson/Getty Images

keeping pharmacists from alerting seniors that they could save money by paying cash — rather than using their insurance — are “unacceptable and contrary” to the government’s effort to promote price transparency.

But the agency stopped short of requiring insurers to lift such restrictions on pharmacists.

That doesn’t mean people with Medicare drug coverage are destined to overpay for prescriptions. Under a little-known Medicare rule, they can pay a lower cash price for prescriptions instead of using their insurance. But first, they must ask the pharmacist about that option…. [Continued at Kaiser Health News, NPR and CNN Money]…