Changes to Part D for Seniors in Doughnut Hole

[Cenla Agent]

If you use force to lower prices for one segment of the population, the prices will have to rise for others.

I do have compassion for people who can't afford their medication. The FDA, as much as any drug company, has kept the price of medication high by limiting options.

Before Part D there was nothing to help seniors, and yes, the desgin sucks. But because of increased demand, drug prices have risen.

I don't know what the alternative is but goverment intervention rarely has the desired effect (see war on drugs, poverty, etc.)

Rick

Rick, you're quite right that lowering costs for one group tends to shift the burden to someone else.

It's not quite true that before Part D there was "nothing" to help seniors, unless you mean there was no Medicare plan. (I'm assuming that's what you mean.) There were a lot of pharmaceutical assistance plans that helped a lot of people pay for meds. Some were income based and some not. I haven't been very involved in dealing with these issues related to Part D over the past two years, but I think a number of these programs are still in place for those in the gap who qualify. Of course they do have to apply for the programs and there are guidelines that have to be met.

I enrolled a number of people in Part D who appeared to be actually worse off than before with Part D, although this was an insignificant minority overall. A lot of group plans took the opportunity to dump their retirement Rx coverage once Part D started as well. Some were better off with Part D or perhaps no worse, but others had previously had much better coverage.

Also, WRT the Canadian gov't, couldn't it be said the same dynamic is at play? The Canucks negotiate with big pharma, who then shifts the burden on us S. of the border?

 

[ronmelton3]

I don't know what the alternative is but government intervention rarely has the desired effect (see war on drugs, poverty, etc.)

Rick

I agree with Rick, but what alternatives are there since the lobbyist own the politicians?
IMHO, until lobbyist are outlawed all that will be done is robbing Peter to pay Paul.

 

[Winter_123]

This is what socialism looks like.

Pharmaceutical companies are being asked to shift from trying to provide lower drug prices to instead take on responsibility for segments of government programs. Negotiating lower prices for a drug based on the volume that goes with a program is one thing. That is a capitalist, free enterprise endeavor where the government may choose another provider with a lower cost and some providers may not choose to bid any lower and participate etc. That is vastly different than telling pharmaceutical companies that they now bear the responsibility for funding a hole in a federal program, whatever that cost may be from year to year, and the pharmaceutical company is now part of that federal program.

Maybe the government will just decide next year that it can save money by lowering the threshold for entering the doughnut hole and shift the burden to the pharmaceutical companies. And what do they have to say about it? After all they are agreeing to serve a program population now rather than make drugs. That is the kind of mindset shift that goes with socialism.

By analogy, we can all agree that automakers should be working toward getting costs down and fuel efficiency up. Who amongst us, though, thinks that is inconceivable that the day will come when the government will just conclude that some people still cannot afford a car so the automakers should be offering an automobile at the price the government sets rather than the underlying economics or competition? Again, the shift is that the industry now takes on federal program responsibilities rather than product responsibilities. The automakers will have a program population to serve as its part in a socialist economy.

The pharmaceutical companies are basically being told that they possess a certain amount of wealth and it is now to be redistributed consistent with the Obama economic model. Yes, it appears that the companies "agreed." But as the automakers are revealing now, more and more private sector enterprises are having guns put to their head. You give a pint of blood- or we will regulate you to death or outright take you over.

Change you can believe in.

 

[G.Gordon]

Winter... good post.

Nail ---> Head

 

[ronmelton3]

I agree, good post

 

[djs]

Not being a medicare person, I have a simple question.... does the price of the drugs impact the donut hole?

I can plead ignorance, since I don't work this market. But if I understand it, the donut hole is a gap in coverage (from $2700 to $6100 in prescriptions?) that Part D doesn't cover. Now, if I'm on some expensive drugs, doesn't the donut hole stay there and the fact that for a short time, I pay less for my prescription just simply keep me in the donut hole longer?

How is this any sort of fix? What am I missing? It's a little bit like a construction company saying we'll rebuild the house for less. It simply saves the insurance company money, the insured still pays the full deductible.

Also, the cost of drugs in this country is in a LARGE part due to the required testing to get approval through the FDA. They have a very narrow window to recover this huge expense before generics are allowed. If you want to lower the prescription costs, eliminate generics and allow the development cost to be spread out over a longer period of time. Otherwise, tell Microsoft to sell Windows for the cost of the CD that it comes on, rather than including their development cost in the program.

Dan

 

[LoriRutl]

Yes, the price of drugs has a big impact on the donut hole. You combine what the plan pays and what you pay to = $2700. Then you are in the donut hole. You pay 100% from $2701 to $3453.75. Once your total out of pocket reaches $4350 you are now in castatrophic coverage where Medicare and the plan pays 95%. You pay $2.40 for generic/preferred, $6.00 or 5% until the end of the year. Jan. 1 it starts all over again.

 

[insurance0707]

The pharmacutical companies will start paying 1/2 the cost while the client is in the doughnut hole for the namebrand drugs. That should help out quite a bit.

 

[GreenSky]

The pharmacutical companies will start paying 1/2 the cost while the client is in the doughnut hole for the namebrand drugs. That should help out quite a bit.

What you really mean is that other people and their insurance will pay 1/2 the cost of the drug when the medicare part d client is in the doughnut hole.

This is not a needs based issue. Everyone get the discount. Keep your eyes open for an across the board increase in medication costs.

Wouldn't the easiest thing to do is to get rid of the doughnut hole, add a $500 annual deductible applying to everyone except for LIS?

Rick

 

[djs]

I'm still confused.

You pay 100% from $2701 to $3453.75

How does discounting the prescriptions change this statement? Would I only have to pay half of the 100% of this range?

I think Greensky is right. If Obama wants to fill in the donut hole, make a donut with jelly filling so there isn't a hole in the first place.

Dan