Pray you never need a pricey drug to keep you alive. Of course, if you are a senior, the odds are that you are going to need one of these sooner or later. If that happens you may be in need of an Artificial Intelligence program to help you figure out how to avoid being fleeced. “But I am on Medicare,” you say. “How can this happen to me?” Read on and find out.
Medicare does not automatically cover the cost of your medications. You need a separate, optional plan for that, which is called Medicare Part D. Lots of companies offer Part D plans. Each of them may charge a different premium. Each of them has a drug formulary or list of the drugs they cover and the amount they will pay for that drug. If you are enrolled in a Medicare Advantage plan, the plan often, but not always, offers drug coverage. If your Medicare Advantage plan offers drug coverage, what drugs it covers will vary from plan to plan.
The Wall Street Journal keeps a vigilant eye on the goings on in our convoluted health care delivery system. They have access to data from Medicare and use it to look for trends and for inefficiencies. In drug coverages, they have found the mother lode.
Depending on your drug plan and where you live, the cost of the same medicine may vary by thousands of dollars per month. Even within the same plan, the cost may vary by thousands. In plain English, that is just crazy.
Because Medicare drug plans do not cover the entire cost of the drugs they approve and agree to cover, these differences in price can force the Medicare beneficiary to pay thousands more in deductibles and co-pays. By way of example, the Journal looked at the prices for a generic prostate cancer drug. We all know generics are cheaper, right? The Journal found that Medicare drug plans had over 2,200 different prices for the same prostate cancer drug. Across the country, the prices ranged from $60 to $7,645 for a one month’s supply. Within the state of Michigan alone, there were huge differences based on the county in which the Medicare beneficiary lived. The lowest prices were in northern Michigan, where they ran about $815 a month. They were twice that in the Detroit area and, if you lived in one of a group of counties along the eastern edge of Lake Michigan, your price was over $3,000 per month.
So how do you protect yourself? This is where your AI buddy comes in because this will be something that is very difficult for the individual person to do. Every year from mid-October to early December is the Medicare Open Enrollment period. This is when a Medicare beneficiary can change from one plan to another. She can go from traditional Medicare to a Medicare Advantage plan or vice versa or can change from one Medicare Advantage plan to another. If she is in a Medicare Part D drug plan, she can change to a different one during this period. Logically, she should take this opportunity to review the available plans and choose the one which provides her expensive medication at the lowest price. The problem is that there are many plans with different prices in different locations. If you have an expensive medication, it may take a lot of investigation to find the plan with the best coverage for you and you have to do it over and over again every year.
This is what one of the Medicare beneficiaries in the Wall Street Journal article had to do. For five straight years, she had to investigate Part D plans to find the lowest price for the cancer drug she needed. For five straight years, she had to change her Part D drug plan to keep her medication costs down.
This is lunacy. Logic and efficiency tell us there should be a single price for a drug that Medicare is purchasing for its beneficiaries. There is no good economic reason for different Medicare Part D plans to have different prices for the same drug and certainly no good reason, economic or otherwise, for an individual plan to charge its members different amounts for the same drug depending on where they live. What does where a beneficiary lives have to do with the price of a drug? As I said at the top, another example of our flawed health care delivery system. Welcome to crazytown.
