2025 Rx $2,000 "light bulb" moment

[annon123]

Tell that to patients with heart and cancer meds.


FARXIGA is for folks with cardiac failure and often CKD as well. There are few substitutes but Invokana and Jardiance are two that MAY be less expensive.

For all the belly aching about limiting the OOP for Rx and health care there are folks out there who might stop taking meds or receiving treatment if not for the OOP cap.

I agree with you.

A friend runs a once a month free clinic where you can't have insurance of any kind to get free care and free meds. (This state did not expand mediciad so that makes the client numbers pretty high.) Each month they turn away people with health insurance who come hoping for the free meds as they can't afford all of their meds (most of them with insurance who can't afford their copays use the one system here that doesn't cut off care or sue you if you end up in collection). If you are really poor medicaid + medicare bails you. If you are above the poverty line but at the lower end of income level it can be too expensive to afford all your meds every day, every month. D, of course, has plans where common generics are free or really inexpensive, but lower income and have some expensive ones you may not fill those Rx's consistently because you then are struggling to make ends meet when you do. So the limit makes sense for that end of the socioeconomic status, although even the $167/mo (=cap/12) may be more than some can afford.

 

[renee15]

I'm pretty sure Medicare will be paying more for drugs than providers. It will bankrupt Medicare...........
Something will have to change.

In 2025 CMS pays 20% of RX costs ( 80% in 2024)
Carrier pay 60% in 2025 ( 20% in 2024)
Drug manufacturers pay 20% in 2025
So the carriers are not happy.

 

[wolf5150]

Let's see if I understand this . . .

If a patient hits their OOP cap . . . Rx, Health care (Medigap or MAPD) . . . they suddenly wants MORE drugs and MORE health care because it is "free"?

The treatment or medication no longer has to be medically necessary?

In all the years I have worked in this industry, including about a dozen years before managed care, I don't recall ever seeing rampant abuse like this.

But I do run across situations where a provider, usually in the mental health field, bills a carrier for non-existent bodies in group therapy sessions.

A gluttonous and misguided society we have become.