<img height="1" width="1" style="display:none" src="https://www.facebook.com/tr?id=302779086974399&amp;ev=PageView&amp;noscript=1"> Medicare Blog | Medicare News | Medicare Information

Medicare Blog | Medicare News | Medicare Information

President Trump Announces Lower Out of Pocket Insulin Costs for Medicare’s Seniors

Posted by www.psmbrokerage.com Admin on Thu, May 28, 2020 @ 01:26 PM

Tags: Medicare Part D, CMS, Prescription Drugs

Prescription Costs Doubled in Last 8 Years

Posted by www.psmbrokerage.com Admin on Tue, Jun 11, 2019 @ 02:08 PM

By Marlene Satter – BenefitsPro – June 10, 2019

According to the JAMA Network Open, between January 2012 and December  2017, prices for 48 out of 49 of the most common brand-name prescription drugs rose. In fact, 78% of the drugs available since 2012 saw an increase in insurer and out-of-pocket costs by more than 50%, and 44% more than doubled in price. MarketWatch reports the median price increases hit 76% over the six years, and some drugs didn’t just have one price increase per year but two. The number of adults over 65 – a growing demographic that takes about a third of all prescription drugs – is going to outnumber the under-18 demographic by 2035, and will have a significant impact on spending.

Source: https://www.benefitspro.com/2019/06/07/brand-name-prescription-drug-prices-double-in-6-to-8-years/?slreturn=20190511150621

Image: www.Canva.com

Additional Updates:

Tags: Prescription Drugs

Spending on Pharmaceuticals to Soar past $370B in 2019

Posted by www.psmbrokerage.com Admin on Wed, May 29, 2019 @ 10:44 AM

Pharmaceutical Spending Will Reach $370B in 2019

Pharmaceutical cost-1


U.S. pharmaceutical spending is expected to grow by 2.5% in 2019, topping $370 billion, while overall healthcare spending is projected to grow by 4% and reach $3.6 trillion, according to a Fitch Solutions report released Monday.

By 2023, Fitch Solutions estimates pharmaceutical sales will top $420 billion, account for nearly 1.7% of the national GDP, and 9.7% of overall health expenditures.

Overall healthcare spending is expected to reach $4.3 trillion during the same period of time.

Source: https://www.healthleadersmedia.com/finance/pharmaceutical-spending-top-370b-2019

Additional Updates:

Tags: Medicare Part D, Part D, Prescription Drugs

Coming Soon to a TV Near You: Drug Prices

Posted by www.psmbrokerage.com Admin on Tue, May 21, 2019 @ 11:37 AM

Drug Prices - TV-1

The Centers for Medicare & Medicaid Services (CMS), the agency that oversees the Medicare and Medicaid programs, have put a rule in place that will change the look of television ads for prescription medications. Last week, CMS announced that most drugs that are covered by Medicare or Medicaid must soon include pricing information in their TV ads.
The prices ads must include are the so-called “list” prices for the medications. In some ways, the list price for a drug is like the Manufacturer’s Suggested Retail Price, or MSRP, from car ads. Just as with cars, some consumers do pay the list price. If they are uninsured, for example, they may have no choice but to pay the list price. Or if they have a high deductible, they may be paying the list price until their coverage kicks in.

Read the press release about the new rule

Read Medicare Rights’ comments on the proposed rule

Source: https://blog.medicarerights.org/coming-soon-to-a-tv-near-you-drug-prices

Image: www.Canva.com

Additional Updates:

Tags: Medicare, Prescription Drugs

Recent Trends in Drug Pricing Show Stark Differences in Brand-Name and Generic Drug Affordability

Posted by www.psmbrokerage.com Admin on Mon, Apr 22, 2019 @ 01:41 PM

A new report from the AARP Public Policy Institute (PPI) examines trends in prices for 390 generic prescription drugs widely used by older adults. The report found that retail prices for these drugs fell by an average of 9.3% between 2016 and 2017; the general inflation rate rose by 2.1% during the same period. This follows two consecutive years of substantial generic drug price decreases; the previous two years saw prices increase.
These price changes have meaningful financial consequences for people with Medicare and others who rely on generic drugs to stay healthy. According to the report, the average annual cost for one generic medication used on a chronic basis was $365 in 2017. This represents a dramatic drop since 2013, when the average annual cost of therapy was more than two times higher ($751).
These findings are in stark contrast with trends in the brand-name drug market, where price increases continue to significantly outpace inflation. In 2017 alone, brand-name drugs widely used by older Americans increased by an average of 8.4%.

Source: https://blog.medicarerights.org/recent-trends-in-drug-pricing-show-stark-differences-in-brand-name-and-generic-drug-affordability

Image: www.Canva.com

Additional Updates:

Tags: Medicare, Medicare Part D, Prescription Drugs

Three Common Misconceptions About The Upcoming Medicare Annual Election Period

Posted by www.psmbrokerage.com Admin on Mon, Oct 01, 2018 @ 04:08 PM

Three Common Misconceptions About The Upcoming Medicare Annual Election Period

Many seniors have become victims of what they think they know about Medicare. Whether you’re new to Medicare or have been receiving benefits for a while, the complexities of Medicare can inspire a plethora of misconceptions.

The Medicare Annual Election Period (AEP) takes place from October 15 until December 7 every year. This allows Medicare beneficiaries to change Medicare Advantage or Medicare Prescription drug (Part D) coverage. Yet an analysis by the Henry J. Kaiser Family Foundation found that a whopping 78% of Medicare Advantage beneficiaries stayed on the same Medicare plan from 2013–2014.

Each year these plans experience policy changes, and seniors will need to look at their policy in comparison to the policies offered in their area. Medicare can be complex, so it's important to have a clear understanding of your options to make the best choice for your needs.

Find Out the Three Common Misconceptions Here.

Additional Updates:

Tags: Medicare, Prescription Drugs

Pharmacists May Soon Be Allowed to Proactively Provide People with Medicare Information about Cheaper Medications

Posted by www.psmbrokerage.com Admin on Mon, Oct 01, 2018 @ 03:57 PM

Pharmacists May Soon Be Allowed to Proactively Provide People with Medicare Information about Cheaper Medications

This week, Congress passed two bipartisan bills aimed at removing barriers that may prevent people from paying the lowest possible price for their prescription drugs. The legislation will prohibit contractual limitations that can stop pharmacists from volunteering information about how consumers may be able to save money on their needed medications.

The Patient Right to Know Drug Prices Act (S.2554) bars insurers and Pharmacy Benefit Managers (PBMs) from restricting a pharmacy’s ability to tell consumers when there is a difference between how much they would pay for a drug using their insurance and how much they would pay without it. This bill applies to plans offered through the Affordable Care Act’s exchanges and by private employers. The Know the Lowest Price Act (S. 2553) provides this same protection for individuals who are covered by Medicare Advantage and Medicare Part D plans.

Read more here.

Additional Updates:

Tags: Medicare, Prescription Drugs

How Devastating Drug Price Increases Are Harming America’s Seniors

Posted by www.psmbrokerage.com Admin on Wed, Mar 28, 2018 @ 12:44 PM

Manufactured Crisis: How Devastating Drug Price Increases Are Harming America’s Seniors

How Devastating Drug Price Increases Are Harming America’s Seniors-1

As policymakers gear up to address rising drug costs, a new report highlights just how much prices have gone up in recent years.

View the full report

The prices of some of the most popular brand-name drugs have increased by 12% on average each year from 2012 to 2017, based on Medicare Part D data, according to a report released by Sen. Claire McCaskill, D-Mo. That's 10 times greater than the rate of inflation during that same period.

Though the number of these prescriptions decreased by 48 million in that window, profits increased by $8.5 billion. Twelve of the 20 medications included in McCaskill's report saw prices increase by 50% between 2012 and 2017. For six drugs, prices increased by more than 100% during that period.

"Can you imagine if you went to an auto dealership and last year's exact model was being sold at a 20% markup, and then you went back the next year and it had happened again?" McCaskill said in a statement. "That's exactly what's happening in the prescription drug industry, where the cost of identical drugs skyrockets year after year."

RELATED: Hospitals—not pharma—to blame for rising healthcare costs, drug experts say

McCaskill's report comes as the Trump administration is planning a multi-pronged approach to lower the drug costs. During his State of the Union address, President Donald Trump said controlling drug costs is a major goal for his administration in the coming year.

The White House's plan includes pushing pharmacy benefit managers to share rebates directly with members, an issue that has been a matter of contention between payers and pharmaceutical companies. Payers take the savings from rebates and apply them across the board to lower premiums, though copays are based on a drug's list price, not the price after rebates.

Drugmakers have deflected blame for rising drug costs by pointing a finger at PBMs.

RELATED: UnitedHealthcare to share drug rebates with 7M members; the Trump administration approves, says HHS' Alex Azar

The administration's plan for drug prices, which was compiled by the Council of Economic Advisers, also suggests that some generic drugs should be offered for free and takes aim at "free-riding" abroad, where countries that have single-payer health systems purchase drugs at a low price, leading pharmaceutical companies to jack up the price for patients in the U.S.

Increasing profits, these companies argue, is crucial to funding additional drug research and development.

Some experts said that the administration's plan is unlikely to drive down costs. Critics have also been skeptical that Department of Health and Human Services Secretary Alex Azar, who headed Eli Lilly's U.S. operations, will lead the charge on drug prices.

McCaskill's report notes that Medicare beneficiaries' spending on drugs is expected to continue to grow over the next several years. Prior research projects that that spending on medications will rise from 41% of per capita Social Security income to 50% by 2030.

Drug prices are a major concern among healthcare executives, and a recent survey shows that 70% feel they may need to operate their own pharmacies to help control costs.

View the full report

Source: https://www.fiercehealthcare.com/finance/rising-drug-prices-healthcare-costs-claire-mccaskill

Additional Updates:
  • America's view on drug pricing and Medicare for all - View
  • 3 Medicare Advantage giants just keep growing - View
  • Increase Your Sales with Our Complimentary Tools - View
  • Express: Mutual of Omaha Weekly Updates - View
  • VALUES Quote of the Week - View
  • Current Agent Incentive Trips and Contests - View

Tags: Part D Premiums, Part D, Prescription Drugs, medicare updates

Majority of Drugs Now Subject to Coinsurance in Medicare Part D Plans

Posted by www.psmbrokerage.com Admin on Fri, Mar 11, 2016 @ 08:28 AM


A new analysis from Avalere finds that a majority of prescription drugs covered by standalone Medicare Part D plans (PDPs) are subject to coinsurance, rather than copayments, in 2016. Coinsurance is when a beneficiary pays a percentage of the cost of the drug, rather than a fixed dollar amount, or copayment. Coinsurance often leads to patients paying more out of pocket compared to fixed dollar amount copayments. The average percentage of covered drugs facing coinsurance has risen sharply from 35 percent in 2014 to 58 percent in 2016 among PDPs. While most PDPs have historically applied coinsurance to high-cost drugs on the specialty tier, plans have extended coinsurance to drugs on lower tiers in recent years, including those covered on preferred and non-preferred brand tiers. Avalere notes that the increase in the use of coinsurance could have far reaching effects, considering 24.6 million Medicare beneficiaries enrolled in PDPs in 2016.


“As coinsurance becomes more common in Part D plans, consumers will find their drug costs are less predictable and will need to rely more on tools like the Medicare Plan Finder to help estimate out-of-pocket costs,” said Colin Shannon, senior manager at Avalere.

Health plans use formulary tiers to encourage use of lower-cost drugs and to negotiate rebates from drug manufacturers in exchange for placement on a lower tier. These strategies help keep premiums low for consumers. In recent years, the percentage of beneficiaries enrolled in PDPs with more than one tier requiring coinsurance has spiked to 96 percent in 2016, up from 39 percent in 2014.

While Medicare rules cap the amount of coinsurance for specialty tiers at 33 percent of the cost of the product, the maximum on non-preferred brand tiers is 50 percent in 2016. By comparison, preferred brand tier coinsurance amounts are capped at 25 percent. 

“These very high rates of coinsurance have shifted our understanding of Part D formulary coverage,” said Caroline Pearson, senior vice president at Avalere. “It will be important to monitor what drugs are being placed on various coinsurance tiers and how plans are using these tiers to manage cost and utilization in the program.”

Interestingly, Medicare Advantage prescription drug (MA-PD) plans use coinsurance much less frequently than standalone PDPs. In 2016, MA-PDs charge coinsurance for only 26 percent of covered drugs—typically for specialty drugs. MA-PD plans may have an incentive to cover drugs at a lower beneficiary cost because they are also responsible for the medical costs of their enrollees, and their incentive to tightly manage drug costs is lower due to their ability to buy down drug premiums using medical cost savings.


This analysis was conducted using Avalere Health’s DataFrame® database, a proprietary database of all stand-alone PDPs and MA-PD plans that uses the Centers for Medicare & Medicaid Services (CMS) data on Medicare Part D plan, MA-PD plan, and formulary design. It also includes additional proprietary and public data sets.

Analysis of 2016 Part D and MA-PD plans uses enrollment data released in February 2016, formulary data released in October 2015, and updated benefit design data released in October 2015.

  • Data reflect benefit design information as submitted by the plans to CMS.
  • A PDP plan in this context is a single product offered in one of the 34 PDP regions.
  • An MA-PD plan in this context is a single option with a unique contract and plan identification number offered in a county; a plan sponsor may offer more than one plan in a county and may serve multiple counties.
  • Plans in U.S. territories, cost plans, special needs plans (SNPs), and Medicare-Medicaid plans (MMPs) are excluded from the analysis.

The top 10 PDPs in this analysis reflect February 2016 enrollment. In 2016, there are 886 PDPs available to enrollees. CMS has placed sanctions on 91 plans and does not report formulary information for those plans. In addition, only blank data is available for four PDPs. All 95 of these plans are excluded from this analysis. In 2016, there will be 1,679 MA-PD plans offered to enrollees. Data for ten plans was not included in the October 2016 formulary file released by CMS.

Source: http://avalere.com/expertise/managed-care/insights/majority-of-drugs-now-subject-to-coinsurance-in-medicare-part-d-plans

Additional Updates:

Tags: Medicare Part D, Prescription Drugs, Coinsurance

    Join thousands of insurance agents who receive weekly news updates and original articles.

    Like Precision Senior Marketing on Facebook!

    Follow Precision Senior Marketing on Twitter!

    Most Popular Posts

    Posts by Topic

    Click for More