Question:
There’s no question today because I want to give a warning and some advice to those who have Medicare Supplements and Stand-Alone Part D prescription drug policies.
Answer
Currently, the drug plans we recommend most often have Tier 3 (Preferred Brand) monthly drug co-pays between $40 or $50. However, in 2024, there’s going to be a major development on most, if not all Stand Alone Part D plans. Instead of those flat and affordable co-pays, in 2024, the same medications will cost the insured 20% to 25% of the retail cost.
Let’s put that into perspective by using Eliquis, which retails for about $650 per month and is probably the most widely prescribed brand name medication in the United States, as an example. Here’s the breakdown of what those who take it will generally spend in 2023: Their initial cost was a deductible of $505 that almost all Stand Alone Part D plans have. After that was paid in January, the co-pay was then around $45 for the next seven months. This month or next, they will fall into the Donut Hole, when all medications are 25% of the retail, $160 for a 30-day supply in the case of Eliquis. This year, the entire cost for that single drug will be around $1,300.
In 2024, those who continue on Eliquis will pay their deductible and then be charged 25% of the cost for the remanding 11 months of the year which will total $2,300, a $1,000 increase from 2023.
More and more people now take non-insulin injectable diabetes medications such as Ozempic, Trulicity, and Victoza, which all have a retail cost of right around $1,000 for a 30-day supply. These drugs will cost $250 per month after the $545 deductible has been met next year and there will be no relief until one has spent about $3,000 out of their own pocket.
These added expenses may push more people to consider Advantage Plans which may be a smart or even necessary decision for some as I don’t anticipate HMOs or PPOs to make the move away from set co-pays for Tier 3 drugs to a percentage of the retail like Stand Alone plans. Advantage Plans currently don’t have a deductible either and I’m hoping that remains unchanged in 2024. If that’s the case, brand name medications will be significantly less expensive for those on Advantage Plans compared to Supplements in 2024. However, the potential medical expenses for those on HMOs or PPOs is also $4,500 to $8,600 higher than Supplements. Therefore, leaving a Supplement isn’t going to be best for everyone.
If you go to almost any other agent or agency other than The Health Insurance Store inquiring about moving from a Supplement to Advantage Plan, you’ll almost certainly be convinced to make that change regardless if it’s in your best interest or not. Let us help you decide what makes the most sense by going over several scenarios and explaining both the risks and rewards of Advantage Plans vs Supplements. Consultations are always no cost and if you would like to sit down and have this conversation before the Annual Election Period and I highly encourage that. You don’t have to wait until the chaos and bombardment of advertising starts in the Fall.
For those who are taking expensive drugs, there are ways to avoid spending more money, but I suggest starting the planning now. My number one piece of advice is to have a discussion with your doctor and explain the burden of these extra costs. Ask if there’s a generic alternative that might be safe and effective. Although some drugs like Eliquis and other meds don’t have a generic equivalent in the US and probably won’t for years, that doesn’t mean there isn’t a generic version of another medication that treats the same diagnosis. Just a couple of days ago I got a call from a client upset at the cost of Linzess, a brand name drug she was prescribed to treat irritable bowel syndrome. It was subject to her deductible and then had a cost of over $200 per month. After complaining to her doctor about this exorbitant cost, he prescribed her a Tier 2 medication that had just a $5 co-pay. Your pharmacist can also be a valuable resource in these situations. Ask for their opinion on possible substitutions.
When it comes to Eliquis and quite a few other brand name drugs, using a Canadian pharmacy has become very popular. Brand name Eliquis is less $100 for a 90-day supply at a pharmacy many of our clients are utilizing and this type of savings is not uncommon at all and available on many meds.
Another great idea is allowing us to review your Stand-Alone Part D plan for 2024. Even if you didn’t originally get your policy from The Health Insurance Store, we can help you choose the best Part D or Advantage Plan for next year. Call one of the offices or email me personally (aaron@getyourbestplan.com) and we will put you in our database. You will then receive our annual recommendation letter prior to the Medicare Annual Election Period that starts in October. Not only will we ensure you’re enrolled in the most cost-effective Part D or Advantage Plan for 2024, we’ll also make suggestions on possible money saving opportunities such as Canadian Pharmacies, Patient Assistance Programs that provide no cost brand name drugs, among others. We have a ton of experience in this area as well as a dedicated “case worker,” as we call Tony Diroma, who works one on one with those people who have extremely expensive medications to help find financial relief.
Make An Appointment
If you would like to make an appointment for a no cost consultation to go over Medicare options, individual ACA marketplace plans, you’re an employer and would like a second opinion on your group policy, or are interested in life insurance, give us a call or email me personally at aaron@getyourbestplan.com. And keep the great column questions coming! Also, I am now licensed in over 20 states and able to help people choose and enroll in Advantage, Supplement, and Part D plans throughout the country.
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Thank you!
If you have any questions or concerns regarding this column topic, or would like to make an appointment for a no-cost consultation, please feel free to give us a call – we would be happy to help. I’d like to remind everyone that I do a live call-in talk show called Medicare A to Z every 1st and 3rd Monday of the month on WMBS Uniontown, 590AM and 101.1FM, from 1 to 3 PM. You can listen in on their website, wmbs590.com.
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