Medicare Part D & Top 10 Drugs: Wide Coverage With Some Sky High Costs

HealthPocket analyzes out-of-pocket costs in Medicare drug plans

SUNNYVALE, Calif., Dec. 5, 2013 /PRNewswire-USNewswire/ -- HealthPocket analyzed Medicare's 2014 drug coverage of the top 10 medications (as determined by U.S. dollar sales) and found these drugs were widely covered but some drugs carried tremendous out-of-pocket cost burdens despite Medicare drug insurance. Four of the top 10 medications were specialty drugs with out of-pocket costs in excess of $1,000 per prescription. Using the average cost-sharing for each drug within both Medicare Part D and Medicare Advantage plans, HealthPocket produced the following out-of-pocket estimates for representative prescriptions of the most expensive drugs within the top 10 list.   

• Humira - $1,395 (a coinsurance fee of 28% drug cost)
• Remicade - $1,005 (a coinsurance fee of 28% drug cost)
• Neulasta - $1,264 (a coinsurance fee of 29% drug cost)
• Copaxone - $1,432 (a coinsurance fee of 28% drug cost)

Out-of-pocket costs in Medicare drug plans can vary depending on the drug plan's coverage period (deductible period, initial coverage period, gap coverage period, and catastrophic coverage period). For example, in the catastrophic coverage period, out-of-pocket costs for the aforementioned drugs would be reduced to 5% of the drug cost. However, catastrophic coverage is only available for drugs that are on a Medicare drug plan's list of covered drugs and the drug plan enrollee must have first spent $4,550 in out-of-pocket costs within 2014.

"Biologics and other expensive specialty drugs like the ones examined within the top 10 list are expected to become more widely used in the next few years," said Kev Coleman, Head of Research & Data at HealthPocket, "The cost consequences of this increased use may lead the government to start regulating the cost drivers and profit margins associated with specialty drugs for Medicare beneficiaries. Another possibility is that the government will adjust Part D cost-sharing to shift a portion of the current out-of-pocket costs for specialty drugs onto the nonspecialty drugs."

Visit HealthPocket.com to read the complete study on Medicare coverage of the top 10 drugs.

HealthPocket.com is a free website that compares and ranks all health insurance plans available to an individual, family, or small business to allow consumers to make their best health plan decision and reduce their out of pocket costs. HealthPocket uses only objective data from government, non-profit, and private sources that carry no conditions that might restrict the site from serving as an unbiased resource. The founders of HealthPocket.com spent decades pioneering internet-based access to health insurance information and created HealthPocket to offer an online resource to positively change how people buy and use healthcare in the U.S. Learn more at www.HealthPocket.com.

For further information, please contact Emily Cashel with Shirley & Banister Public Affairs at (703) 739-5920 or (800) 536-5920 or [email protected].

SOURCE HealthPocket