Good while it lasted

[Kentucky1]

I know in the scheme of all we have to deal with this is more of an aggravation than a major issue, but just needed to vent. Last year I turned 65 and went on Medicare. I was pleasantly surprised when I discovered that my Med D plan was going to greatly reduce my out of pocket expense for Abiraterone. My old standard insurance had me paying hundreds of dollars per month. The saving grace was that I would meet my out of pocket limit fairly quickly, usually by mid year. When I changed to Medicare last June I was happy to see that my out of pocket expense was only about $150 a month, that was 40% of a cost of $330. This year under the same plan my co-pay will now be almost $900, with the first month being about $1300. The plan says their cost is now $2600! How can it be that a medication that costs $330 in December, now cost $2600?

I think this is blatant money grubbing on the part of the insurance plan and definitely feel they are taking advantage of people who really have no choice or limited choice. I am a retired pharmacist and am well aware of the lack of transparency in drug pricing throughout the pharmacy/insurance industry. I am wondering why someone like Morgan and Morgan or some other huge law firm hasn't initiated a class action lawsuit against these insurers regarding these types of pricing practices. Funny thing, I can use GoodRx and pay about $250 a month, which is what I will do.

[mrscruffy]

I know the Pharmaceutical companies are fighting legislation that would allow medicare to negotiate prices with drug companies. If Pharma doesn't like it you know it is good for us. I currently pay $595 a month for my COBRA and Abiraterone costs me $15 a month. Going to medicare in March may have to get with my broker and see if COBRA is better, I can do it for another year

[Alturia in reply to mrscruffy]

I agree with your point about pharmaceutical pricing, but each year there is an open enrollment period when you can compare coverage for the coming year and change companies if you need to. If you had used the tool on the Medicare web site you probably would have found an insurance plan that would cover that drug for the $150 you had been paying for it. I have been on Medicare for 6 years and have changed Part D insurance plans 4 times because companies changed the pricing for 1 or more drugs I was taking.

[Kentucky1 in reply to Alturia]

I was fine with the plan with the cost being $350 of which I paid 40%. The price change happened after open enrollment, so I would not have had access to that information. You can rest assured that I will be looking come next year. I worked with a Medicare supplement agent prior to choosing the plan last year. The plan I chose was the best one we could find to cover all the meds I am on at the time. You can rest assured I will be looking again at my choices next year. Thanks for your input.

[Alturia in reply to Kentucky1]

Yes the price change would have taken effect on 2022 AFTER the open enrollment. But that's the whole purpose of the open enrollment. It allows you to make changes effective with the next year - in this case 2022. The plans always have to send out new formularies and premiums for then coming year. This usually goes out in late October. It is up to you to review the changes to see if you are still happy with the plan or whether you want to change.

[btca in reply to Kentucky1]

That price change is an ongoing practice. They show a policy price, deductible, co-pay for the "open enrollment" period,---but--- their price always goes up for the following year's plans in Feb.

[Kentucky1 in reply to Alturia]

Your post got me digging further into this quagmire. Turns out that it looks like the difference is in the pharmacy I am using. It appears as if I change from Kroger to Walgreens my price returns to a more reasonable $176 per month after the first month. Thanks for your suggestion, it's going to save me a bunch of money.

[Alturia in reply to Kentucky1]

Glad to hear it. That's the other Thing that can change. Pharmacies can no longer be in network. The tool on the Medicare web site enables you to verify that also each year.

[Vangogh1961 in reply to Alturia]

Costs can vary pharmacy to pharmacy even in network. It's good to check all pharmacies that you're contracted with.

[Kentucky1 in reply to Alturia]

Funny thing is that my plan still shows Kroger as in-network. Out of 7 choices for specialty pharmacies only Walgreens is showing the $250 co-pay. The other 6 range from 550 to 1600.

[mrscruffy in reply to Alturia]

I wasn't paying $150 I was paying $15. With other options available COBRA may be cheaper in the long run

[dhccpa in reply to Alturia]

Yes, very important to check drug pricing every year at renewal time to determine which plan will have best pricing for your particular drugs during the next year.

[Hidden in reply to mrscruffy]

I've seen the political ads big Pharma is running to fight that legislation. Completely dishonest. They all but come out and say if you support that we won't be able to afford to develop vaccines for pandemics and you're all going to die. Nice, huh? I'm disgusted with the dishonesty of political ads, this being just one example.

[mrscruffy in reply to Hidden]

Yes, underhanded and deceptive at best

[Jvaughan0]

I agree. All medical expenses feel like a shell game. Some prices are unbelievably inexpensive, while others seem to be priced on the road to ruin. My Medicare Advantage coverage has been reasonable so far, but there is always the fear coverage will change or someone is going to code treatment in such a way that it will break the bank. I have hear that "depends on how it is coded" so many times. Another needless source of anxiety...

[mrscruffy in reply to Jvaughan0]

I have the luxury of speaking directly to the insurance advocate at CTCA, she has saved me about 5k in the last 5 years

[jimreilly]

yes, anxiety making, which is exactly what no one who is fighting cancer needs

[cesces]

Dear Kentucky1

The real problem is the voting patterns of seniors voting for politicians who cater to their emotional needs while vigorously supporting a US kleptocracy.

Have you checked out the shenanigans engaged in, non-stop by Kentucky's two Senators?

Lol

The solution is in our hands.