Medicare announces lower prices on 10 common, high-cost drugs

[MULTIZ321]

Medicare announces lower prices on 10 common, high-cost drugs

Medicare announces lower prices on 10 common, high-cost drugs

The negotiations with drugmakers are projected to save older adults $1.5 billion in out-of-pocket costs when the new prices go into effect in 2026.

www.nbcnews.com

Richard

 

[DrQ]

What the big print giveth, the small print taketh away:

"The prices won't take effect until 2026,"​

 

[DeniseM]

As I recall, the underlying legislation features a reduction/cap on 10 drugs each year, starting in 2026. However, it capped insulin starting in 2023, and also lowered the price of adult vaccines starting in 2023. I'm no expert, but this legislation has multiple components and is designed for a structured roll-out with some components kicking in each year. So yes, it's disappointing that this phase is not starting until 2026, but it's common knowledge.

Please don't @ me with your superior knowledge of politics & science - I'm not interested in a debate.

 

[DeniseM]

After his open heart surgery in November, Rod started taking Xarelto, so this will help us. Currently, we're paying $504 after his prescription coverage.

 

[eschjw]

Before I got on Medicare, I gave myself shots of Enbrel and I had a $35 copay per month on my insurance. When I went on Medicare the part D cost jumped to over $6,000 a month. The doctors move you to drugs like Remicade which require infusions in a medical setting costing $6,500 and 80% is covered under Medicare part B. My Medigap policy pays the rest and my only cost is the yearly deductible.

When I first heard about the change for 2026, Enbrel was going to be covered under Medicare Part B. Based on what I just read it is still going to be under Part D. Medicare would save about $2,000 a month if I could just give myself the weekly shots under Part B. Bummer!

 

[rapmarks]

After his open heart surgery in November, Rod started taking Xarelto, so this will help us. Currently, we're paying $504 after his prescription coverage.
View attachment 97963

My brother in law also on that drug. I was so happy to see this news. who knows, we can end up on these drugs.

 

[jp10558]

After his open heart surgery in November, Rod started taking Xarelto, so this will help us. Currently, we're paying $504 after his prescription coverage.
View attachment 97963

Man, like @eschjw said, I don't know how prescription drug coverage is over ~$90 every 3 months if you've got a medicare prescription plan.

 

[rapmarks]

Man, like @eschjw said, I don't know how prescription drug coverage is over ~$90 every 3 months if you've got a medicare prescription plan.

Not sure what you mean, but I spend well,over $2000 a year on prescriptions and I have a pretty good plan with no high cost drugs.

 

[jp10558]

I just mean that Medicare should not be worse than common commercial plans. I know they often are, just saying that with the size of it, it ought to be able to match any commercial insurers group rates if the world was just.

 

[rapmarks]

I just mean that Medicare should not be worse than common commercial plans. I know they often are, just saying that with the size of it, it ought to be able to match any commercial insurers group rates if the world was just.

Not only that, but if you acre over a certain income, you pay IRMA on your prescription plan cost to.

 

[jorcus]

Before I got on Medicare, I gave myself shots of Enbrel and I had a $35 copay per month on my insurance. When I went on Medicare the part D cost jumped to over $6,000 a month. The doctors move you to drugs like Remicade which require infusions in a medical setting costing $6,500 and 80% is covered under Medicare part B. My Medigap policy pays the rest and my only cost is the yearly deductible.

When I first heard about the change for 2026, Enbrel was going to be covered under Medicare Part B. Based on what I just read it is still going to be under Part D. Medicare would save about $2,000 a month if I could just give myself the weekly shots under Part B. Bummer!

The way I read it your total out of pocket cost should be $2000/ year in 2025 and can be paid in monthly instalments. Worth looking into.

Saving money with the prescription drug law

A new prescription drug law that went into effect January 1, 2023, will help save money for people with Medicare.

www.medicare.gov

 

[eschjw]

The way I read it your total out of pocket cost should be $2000/ year in 2025 and can be paid in monthly instalments. Worth looking into.

Saving money with the prescription drug law

A new prescription drug law that went into effect January 1, 2023, will help save money for people with Medicare.

www.medicare.gov

Yes this change for 2025 will eliminate the doughnut hole and is a welcome change. Currently the hole lasts until you have paid $8,000 out of pocket. My total out of pocket drug costs this year will be around $1,000 and my insurance cost for 2024 will be less than $400.

It will be interesting to learn how much insurance will cost for my formulary with and without Enbrel in 2025. I may decide it is worth the money for the convenience of using Enbrel. My wife has one very expensive drug and she will go deep into the doughnut hole with about $6,000 out of pocket for 2024. The new 2025 $2,000 out of pocket limit should save her about $4,000 a year. The big unknown is how much the insurance costs will go up.

 

[Tia]

Nice of the drug makers to have agreed to lower prices. I have read about people using Canadian pharmacies and going to Mexico to get their RX's for le$$.

I saw an orthopedic surgeon yesterday and he said Medicare keeps dropping the reimbursement for them. He had a friend testifying before Congress recently about this, but said the Lobbies for the big players have a lot more $$$$$$$$$$$$$$$$ to spend on lobbying .

 

[rapmarks]

I was scheduled for Petscan next Friday. Received call yesterday that my Aetna Medicare advantage has denied it. I can have a Catscan next april. I guess they know more than my oncologist,vwho appealed it and was denied

 

[susieq]

Insurance Companies should be sued for practicing medicine without a license!

 

[Tia]

Insurance Companies should be sued for practicing medicine without a license!

They are the ones running everything now , they make the decisions . Lots of expensive lawyers helping them

 

[Talent312]

I was scheduled for Pet scan next Friday. Received call yesterday that my Aetna Medicare Advantage has denied it. I can have a Cat scan next april. I guess they know more than my oncologist, who appealed it and was denied

Stuff like this reinforces our decision to avoid Advantage and stick with original Medicare plus Medigap plans. Yeah, it costs a heck of a lot more, but we and our docs call the shots (so to speak).

 

[WorldT]

I just mean that Medicare should not be worse than common commercial plans. I know they often are, just saying that with the size of it, it ought to be able to match any commercial insurers group rates if the world was just.

One reason for this on the medication side had to do with the fact that prior to this legislation, Medicare had to pay the list price for medications. The manufacturers raised prices however they wish and Medicare, by law, couldn't negotiate.
Commercial plans always negotiated and never paid list price.

 

[rapmarks]

Stuff like this reinforces our decision to avoid Advantage and stick with original Medicare plus Medigap plans. Yeah, it costs a heck of a lot more, but we and our docs call the shots (so to speak).

Following my surgery and during radiation I was given tramadol. I was allowed to refill my prescription one time. With that refill came a notice that they were allowing this refill but would definitely not be allowed any more refills. I never was able to take pain meds before, didn’t like the effects, but the pain in my mouth was so great that I was swishing lidocaine all day. I don’t know if all prescription plans are like this, but again my Medicare advantage plan restrictions

 

[WorldT]

Autocorrect did a number on you post there .
I guess you were trying to write "tramadol". If it is, what you likely ran into was effort to reduce the "indiscriminate" prescription of opioids. Those in pain are understandably not particularly excited about those restrictions.
A prior authorization would get you the tramadol.

 

[rapmarks]

Autocorrect did a number on you post there .
I guess you were trying to write "tramadol". If it is, what you likely ran into was effort to reduce the "indescriminate" prescription of opioids. Those in pain are understandably not particularly excited about those restrictions.
A prior authorization would get you the tramadol.

Thanks , I didn’t notice The correction.

 

[Talent312]

Following my surgery and during radiation I was given tramadol. I was allowed to refill my prescription one time...

Don't get me started on Tramadol...
Last year, when DW had knee surgery, her old-school surgeon gave us paper prescriptions. I fortuitously copied them before taking them to the pharmacy. One was for "60" Tramadol.

An idiot clerk at CVS somehow put "3" in their 'puter in place of 60, so that is what their doofus pharmacist issued without checking. I quickly returned it with my copy of the Rx, I asked, "How do you take 4 x a day, with only 3 pills? Can you see the steam coming out of my ears?" and made the motion of steam coming out.
.

 

[DrQ]

Cap on Drug Costs Will Save Millions an Average $1,500 Next Year: Analysis​

Biden Cap on Drug Costs Will Save Millions an Average $1,500 Next Year: Analysis

The new cap on out-of-pocket prescription drug costs enacted as part of the 2022 Inflation Reduction Act will save

www.thefiscaltimes.com

 

[steved2psi]

Before I got on Medicare, I gave myself shots of Enbrel and I had a $35 copay per month on my insurance. When I went on Medicare the part D cost jumped to over $6,000 a month. The doctors move you to drugs like Remicade which require infusions in a medical setting costing $6,500 and 80% is covered under Medicare part B. My Medigap policy pays the rest and my only cost is the yearly deductible.

When I first heard about the change for 2026, Enbrel was going to be covered under Medicare Part B. Based on what I just read it is still going to be under Part D. Medicare would save about $2,000 a month if I could just give myself the weekly shots under Part B. Bummer!

I replaced Enbrel with Cimzia. I get monthly shot in Drs office. Part B. Works better in my opinion.

 

[SusanRN]

Nice of the drug makers to have agreed to lower prices. I have read about people using Canadian pharmacies and going to Mexico to get their RX's for le$$.

It was not "nice" of the drug makers to lower prices. The current president's Inflation Reduction Act of 2022 allowed Medicare (the country's biggest drug purchaser), for the first time, to negotiate prices and to reduce and eventually eliminate the "donut hole." Definitely a big help for us oldsters!