Short Takes On News & Events

Strange Pricing Details Can Bedevil Medicare Beneficiaries

By Susan Jaffe

November 13th, 2013, 1:48 PM

Pharmacist Gina Upchurch knows all the ins and outs of the Medicare prescription drug benefit and was sure she discovered something very wrong:  using the government’s online plan finder tool to help seniors compare dozens of 2014 drug policies, she noticed that some insurers charge higher prices for a prescription filled every two or three months compared to the same drug bought every month.

“You’re buying less and paying more,” said Upchurch, executive director of Senior PharmAssist, a nonprofit group in Durham, N.C.

Seniors have until Dec. 7 to sign up for drug coverage next year. Medicare advocates urge beneficiaries to compare plans each year because they may find a way to save money, but many people find the process so complex that they don’t switch plans.  Medicare’s plan finder allows seniors to narrow their choices by entering their drugs, dosages and pharmacy preferences, to obtain a list of available plans and their premiums, deductibles and drug costs.

Eye drops, creams, or inhalers are drugs that can last more than a month, although some insurers don’t offer discounted pricing for other than 30 days, said Upchurch.  For example, under one plan she reviewed, a beneficiary who has a monthly prescription for eye drops would pay $7 a month during the initial coverage period to get the drug, while another person who has a prescription for the drops to be filled every 60 days would pay $51.  She also said that two plans she compared charge $40 or $45 for three vials of insulin every month in the initial coverage period, and $575 every two months.

She noted that seniors sometimes can get the lower prices if they use pharmacies or mail order programs designated by the insurers, rather than just picking one themselves.

Although price disparities might be confusing, a Medicare spokesman said, they are aimed at providing more accurate information about the plans. “These features are not problems with the plan finder.”

He pointed out that a footnote on a different web page with plan details explains why a small supply of a drug can cost more than a larger one: “This drug is covered by the plan, however, the plan does not offer a benefit for the frequency and pharmacy type you selected.  Therefore, the cost displayed is an estimate of the full cost of the drug for the frequency entered.”

If seniors are taking a medication with a frequency other than once a month, they should call the drug plan to verify costs and ask if there is a lower price at the plan’s preferred retail or mail order pharmacy, said Fred Riccardi, director of client services at the Medicare Rights Center, a consumer advocacy group in New York City.

“But people shouldn’t have to run around to different pharmacies,” said Upchurch.  “It would be better if Medicare required plans to cover whatever supply a provider prescribes.”

Susan Jaffe can be contacted at

This article was produced by Kaiser Health News with support from The SCAN Foundation.

6 Responses to “Strange Pricing Details Can Bedevil Medicare Beneficiaries”

  1. Jennifer Hu says:

    I so agree, this running around and spinning your head three times to get meds is ridiculous. Just another way to squeeze another dollar out of elderly without telling them. Could call it elder abuse if you think about this.

  2. Jessica says:

    This is so sad. Healthcare is complex enough and many elderly don’t even know how to use the computer to compair the plans. If the government wants to overhaul healthcare why don’t they start with protecting our seniors.

  3. Ruth Sweeney says:

    Single Payer system would solve so many of these profit-oriented issues..

  4. tony says:

    To all the above,

    You sound so naive! Don’t you keep on voting for Republicans? It’s no secret that Republicans are working as hard as they can, both locally and nationally, to kick seniors to the curb. There was a time when Republicans would disguise their ugly and mean spirited agenda. Not any longer! They openly say they want to cut funding to programs that benefit the poor and elderly. They constantly prove it by the way they vote in Congress. They refuse to touch the defense budget but they will readily slash Medicare, Medicaid, Social Security and nutrition programs as quick as they can. Just look at the budget that Congressman Paul Ryan proposes. His budget is absolutely brutal to the poor and the elderly while it does virtually nothing to curb our massive defense budget. Republicans are hateful and mean and they do not deserve the senior vote. Stop being so naive!

  5. walt says:

    Right on, Tony. I have no sympathy for those who vote Republican – if you foul the bed, you can lie in it.

  6. Marni says:

    Another reason we should not have to use several different pharmacies is that the pharmacist is a part of the “checks” system that can decrease the risk of adverse drug interactions IF the pharmacist is aware of all of the prescription medications a person is taking. If a person is using more than one pharmacy, each of the pharmacists involved will be at a disadvantage when trying to provide this protection. In addition, some medications have multiple brand names; I have known of a person who inadvertently was taking a triple dose of a medication daily because 3 different doctors has prescribed the same medication under different brand names and the patient wasn’t aware of the concept of checking the generic names before adding a medication to her regimen.