I received the following email message today, so it seems any efforts by special interests to prevent the cap from being enacted have been diffused. This will mean thousands of dollars in annual savings for those on Tier 3 and 4 drugs. I'm still on three Tier 1 generics, but I never thought I'd live to see such a yearly cap for drug costs.
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Medicare dot gov logo
Starting in 2025: Yearly out-of-pocket costs capped at $2,000 for prescription drugs covered by Medicare
Mark your calendars — Medicare Open Enrollment starts October 15! Did you know new benefits are coming to Medicare drug coverage next year?
Starting in 2025, all Medicare plans will include a $2,000 cap on what you pay out-of-pocket for prescription drugs covered by your plan. So, it's more important than ever to make sure your drugs are covered.
Also starting next year, you can choose to participate in a program that spreads your out-of-pocket drug costs across the calendar year, instead of paying all at once at the pharmacy. It's called the Medicare Prescription Payment Plan — and you can opt in with your plan throughout the 2025 plan year. Contact your plan for more details.
Preview Coverage Options
Remember, Medicare plans can change from one year to the next, and so can your health needs. Preview and compare all your health and drug options and see if you can save!
Sincerely,
The Medicare Team
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Significant help for some of us to keep staying S&W,
cujoe
Written by
cujoe
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I'm not sure why this cap on drugs is so exciting to people. It baffles me. It comes at the expense of others. To keep the part D premiums from increasing, the government is pumping in an additional 5 billion dollars. What happens next year when there are not election consequences? Reimbursements to doctors have been cut and more doctors are dropping medicare coverage and/or cutting the number of medicare patients. More patients seeking fewer medicare enrolled doctors doesn't sound good to me. I'm still 7+ years from medicare, I doubt all this happy dance about a 2k cap on drugs will still be going on.
Tell that to someone on a fixed income who is paying north of $15K on top of insurance premiums for drugs essential to their survival. Medical care in this country is a train-wreck for sure, but the insurance and pharma companies like it that way.
Well..if one is only concerned with retiree fixed income patients and ignores the millions of others who are not part D eligible, one might want to consider where the cost will be transferred to cover this new benefit starting next year. There is no free lunch
We are the only western country without national health insurance. Medicare-for-All like most other good ideas, ends up in the legislative dust bin due to powerful special interests lobbying and partisan politics. No one in the country should go to bed worried about what might happen if the next day someone in their family has a accident or is diagnosed with a disease. And old and young generations should not have to engage in political warfare over what should be a right of every citizen.
And, Yes, I am on Medicare - and would be a fool at my age and income not to be. Thus, the salutataory "Significant help for some of us to keep staying S&W"
BTW, under my current non-SOC treatment (by personal choice) this cap will have zero impact on my expected drug costs for 2025.
The average full cost of any new cancer drug on patent is north of $100K (and that's the low side). Under the wacky stand alone Part D, for anyone on Tier 4 drugs, pays an upfront deductible (either fully or partially thru increased premiums, then nothing in the "donut hole", and then when a max out-of-pocket expenditure is reached one goes to "catastrophic" benefits which cover a major portion for the rest of the year. The $2K cap will change some or all of this.
Each year the insurance companies that provide drug benefits revamp their coverage. The premiums change, along with their drug formularies, cost sharing with various pharmacies, etc. - with no consistency as to what drugs fall into which formulary "tiers". For example I had to switch from dutasteride to finasteride this year because, my new plan had dutasteride as a Tier 2 drug for which I would have had to pay a ridiculous "retail" price (until I used up my $500+ deductible), as it is a generic. On top of it all, insurance plans are individualized for every state. (Believe me, no one other that pharma in collusion with insurance could have dreamed up such a confusing system for drug insurance.)
Last year I got my scripts through an online subscription service, Scritpco. I did that even though I was paying monthly for a Part D Plan, as the cost was less that using the insurance. (Note that if you do not sign-up for Medicare or a drug plan when you first qualify, you will pay a yearly premium surcharge for all years later. There may be some exceptions for people who continue to work and have insurance elsewhere.)
Mark Cuban's CostPlus Drugs is often the best source for recent drugs that have just come off patent. His site show the retail price, the cost to manufacture, and cost via his service. Here is the cost for Abiraterone.
Listen, I'm not getting in a tit-for-tat with you. We don't have a national health insurance program and probably never will.I'm just illuminating the fact that to achieve this 2k cap, costs will be transferred to others in a variety of ways. And many who bear this new cost will be working class on a fixed income without this new fantastic benefit.
I do not disagree. On top of it all we have an influx of immigrants who are likely getting free health care (and housing and EBT cards) while our tax-paying citizens declare bankrupsy over unpaid medicla bills. Term limits (maybe age as well), 100% public financing of all elections. staggered 4 year terms for house reps, restricted employment by gov employees in any industry they regulate, banned insider-trading by government officials, etc. etc. - None will ever happen as long as those in power in both parties are benefiting by the status quo. (I didn't intend for this to be a political post, but here we are.)
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