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Problems With Medicare Part D


Stanley Feld M.D.,FACP,MACE

I have discussed Medicare Part B and Part F in recent blogs. A reader asked about Medicare Part D


Dr. Feld 

“Please discuss Medicare Part D, the drug benefit plan available to seniors. It is very complicated and completely confusing to me.

My physician gave me a prescription for Levequin 500 mg once a day for 10 days. The pharmacist told me it would cost me $330 dollars. Medicare Part D would pay an additional $110 dollars for a total of $440 dollars.

 I asked the pharmacist if there was a generic equivalent. The answer was yes. It cost $10 dollars.

 This is unconscionable. It is highway robbery.




Several issues are presented in this readers note. It is essential to understand these issues. The issues are an indictment against government “controlled” programs.

On the price for Levaquin500mg Tablets  is 185.98 for 10 tablets. 

"There is a generic equivalent ; Levofloxacin is a 3rd-generation fluoroquinolone antibiotic, marketed by Ortho-McNeil under the trade name Levaquin in the United States.  Levofloxacin was launched in the Japanese market in 1993". 

The generic version of Levaquin is Levofloxacin. Levofloxacin 500mg tablets cost $51.08 for 30 tablets or $17.08 for 10 tablets. Wal-Mart’s price is less at $20 for 30 tablets. 

Levaquin is marginally more potent than Cipro, which also has a generic equivalent. Wal-Mart’s price for 30 tablets of ciprofloxacin 500mg(generic Cipro) is $20.  

  I am sure the reader’s physician did not know the differences in the prices of the drugs.

The Medicare Part D benefit was created to help senior citizens pay for their medication at affordable prices. If a person has an illness that needs medication that person has to be able to afford the medication. Taking the medication is important to prevent the complications of chronic diseases. It is well established that 90% of the Medicare healthcare dollars are spent on treating the complications of chronic diseases.

Adherence or compliance with prescribed medication is only about 50%. Compliance was lower before Medicare Part D. Many seniors had to make a choice between food and medication. Many seniors still have to make the same choice.

Tzu said 2500 years ago,

Today’s battles are information battles because information shapes both perception and opinion.  Those who use it to both and attack and defend will win, those who do not will lose”.

The healthcare insurance industry controls the data for both employers and the government. It is the administrative service provider for both employers and government.  It is no surprise that it is the winner. The losers are patients and the government.

United Healthcare will pay AARP $4 billion dollars over seven years to be the only provider of AARP’s Medicare Part D plan.

Does anyone think United Healthcare does this if they thought they would lose money?  Part D is supposed to be a plan subsiding drug benefits for seniors. The government is supposed to set premiums for all seniors regardless of health risk.

Last year United HealthCare’s net income from Medicare Part D was over $1 billion dollars. United Healthcare expects this net income to increase in the future as more baby boomers qualify for Medicare Part D coverage using AARP’s exclusive United Healthcare Part D plan.

 Despite all the profit from Medicare Part D in 2008 the premium for seniors increased from $25 to $28 per month per senior in 2009. The premium started at $14 per month per senior 2006. In 2011 the premium has increased to $41 per senior per month. Medicare Part D’s premiums are paid for with after tax dollars.  United HealthCare’s profit from Part D has grown even higher.

Dennis Kucinich said. "It’s clear that they didn’t want me upsetting their multi-billion dollar applecart,"

"The health care plans of the invited candidates preserve and promote the interests of for-profit insurance and pharmaceutical companies at the expense of tens of millions of everyday Americans who either can’t afford coverage or are being over-charged for the inadequate coverage they struggle to afford."

I believe the government’s intentions were good. However, after vested interests manipulated the rules and regulations, Medicare Part D has turned out to be less effective and more costly than anticipated for both seniors and the government.

The government and seniors are being ripped off by the healthcare insurance industry. The government is doing nothing about it.

Medicare Part D premium provides coverage until prescription costs reach $2830. After $2830 the patient pays 100% of the drug cost until his out of pocket expenses reach $4550. Thereafter, the patient pays 5% of the drug costs and the government subsidies the remainder.

The co-pays before patients reach the “donut hole” varies depending on the drug and the healthcare carrier. Co-pays for generic drugs are $4. Co-pays for healthcare insurance carriers preferred  branded drugs are $25.  Co-pays for healthcare insurance company’s non-preferred drugs are $54 or more. This is the reason for the $330 dollars co-pay in the readers note.

The total costs are added to the amount credited toward patients “donut hole” even though the patient paid the co-pay.

It is confusing for intelligent people. Just image how confusing it must be for an 85 year old with some disabilities and limited income.

Consumers can buy a month supply for a generic drugs at Wal-Mart for $4 cash without a charge being made to their donut hole. Some healthcare insurance companies charge $20-40 dollars toward the donut for a $4 generic drug. The insurance company pays nothing for the drug because the consumer already paid the $4. None of these maneuvers are transparent. The healthcare insurance company controls the data.

Despite all of these co-pays and insurance premiums, the government spends $51 billion dollars a year subsiding Medicare Part D.

Something is wrong. It must be money wasted by the CMS bureaucracy, faulty CMS oversight of the healthcare insurance industry or non-transparent pricing by the healthcare insurance industry.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.









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