Sitkans Offered Aid Cutting Drug Costs

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Category: News

Created on Monday, 14 October 2024 14:37

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By GARLAND KENNEDY
Sentinel Staff Writer
    Open enrollment for Medicare Part D begins Tuesday for those who are eligible, and the price of some medications covered under the program, as well as the maximum out-of-pocket costs, have gone down this year, a local expert on health programs reports.
    The enrollment period continues until December 7, giving Medicare recipients – people who are over 65 or are on Social Security disability – a chance to review plans and ensure they pick the one that covers their needs at the lowest cost, SEARHC patient health benefits specialist Susan Briles told the Sentinel.

Susan Briles. (Sentinel File Photo)

    The open enrollment period is only for Medicare Part D, which covers prescription drugs.
    “Because of the Inflation Reduction Act there’s a couple different, exciting things,” Briles said. “Insulin was capped at $35 a month; that happened this last year, so that’s huge for, obviously, diabetics. This year, in 2025 the absolutely, unbelievably huge news is that out-of-pocket drug costs are capped at $2,000. After helping people for so many years with prescription drug coverage, I can tell you people have unbelievably high drug costs.”
    Even with Part D coverage, patients have had to pay costs running into five or six digits, Briles said.
    “For instance, a guy here in town takes two brand name expensive prescriptions that treat the same thing. So usually in the formularies that these plans have, they only cover one brand name drug for each of the diseases… When we looked him up, we found one plan out of the 19 that covered both of them,” Briles recalled. “So we lucked out. That plan, the cost of his drugs, plus his premium for the whole year was about between $11,000 and $12,000, which I know sounds horrible, right? The next one above that was over $65,000, and the next one, all the rest of them, were well over $100,000.
    “So can you imagine when this guy comes in this year and I say, ‘Oh, you’re going to pay a whopping $2,000 no matter what medication you’re on.’ For a lot of people who take brand name drugs, this is going to be a game changer.”
    Also new this year following the passage of the Inflation Reduction Act in 2022, Medicare can now negotiate drug prices, and has done so for ten commonly needed prescriptions. These include the blood thinner Eliquis; an arthritis treatment, Enbrel; and a diabetes treatment, Januvia.
    The most important change in Medicare plans this year is “just affordability, really. The more you go to doctors, it seems like the more you hear about these medications being prescribed,” Briles said. “To anyone, everyone, everywhere, over the age of 65 or on disability with Medicare, this is going to make a huge difference. The average person I meet with probably doesn’t spend much more than $2,000 out of pocket, but even if it’s $4,000 out of pocket that they spend, that’s still $2,000 back in your pocket.”
    Briles said she often hears from people wishing for more affordable health care, and said this year’s price reductions are a step in that direction.
    “I think affordability is where we’re going to see the benefits this year. You hear so many complaints – reasonable complaints – about the cost of groceries, the cost of gas, all understandable and reasonable. I understand; I feel your pain, because I have it too. But I mean, there are some really positive things coming in 2025,” she said.
    It’s important for someone looking to register for a Medicare Part D plan to call Briles’ office, she said, to make sure the person finds the best deal.
    “People who are aging into Medicare need to get hold of us so they get signed up for the right plans,” she said. “People who are already on Medicare who do not have retirement coverage, like Alaska Care or federal Blue Cross, need to call us to do a quick plan evaluation to make sure you’re not going to be spending more money than you need to spend in 2025,” Briles said.
    With open enrollment about to begin, Briles cautioned Sitkans about scams. Medicare does not reach out to people by phone or social media. Briles encouraged Sitkans to hang up the phone if the caller is claiming to represent Medicare, and call her office instead. To report a scam or schedule an appointment her number is 907-966-8684.
    Medicare Part D, which launched in 2006, was somewhat difficult to work with at first, Briles said, but it has improved over time, and this year’s price cuts represent a seismic shift, she said.
    “These are small, incremental changes, but this $2,000 (out-of-pocket price cap) I feel is the biggest one I’ve seen.”