Retail Price for Some Drugs Is Cheaper Than Part D Plans

Some California beneficiaries have found lower prices for their prescription drugs in the open market than those negotiated by their Part D plan. Two such cases have recently been brought to our attention.

One example is with a drug, Finasteride. A beneficiary found that it cost her 2.5 times more to get it in her Part D plan than at Costco. Therefore, she bought her prescription at Costco instead of using her Part D plan. Subsequently, what she spent at Costco was not counted toward her  TrOOP (true out-of-pocket expenses). In this case, it happened to be a plus for her since it delayed her entrance into the coverage gap, or donut hole.

In another case, a beneficiary’s Part D plan drug copayment was higher than the retail price for the same drug outside the plan.

We have notified the Centers for Medicare and Medicaid Services about this issue.  Yet, it’s unclear what CMS can do since the Medicare Modernization Act (MMA) of 2005 prohibits the federal government or the Secretary of Health and Human Services (HHS) from negotiating Part D drug prices.

If you hear of additional cases like this, let us know. You can also contact your Congressional Representative or Senator to voice your concern on this issue.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.