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Higher copays coming for Medicare brand-name drugs

WASHINGTON — With three weeks left for seniors to change their Medicare prescription plan for 2012, a study brings distressing news: Copays for brand-name drugs are going up — sharply in some cases.

Copays for preferred brand-name drugs will increase by 40 percent on average next year, and nonpreferred brands will average nearly 30 percent more, according to the study by Avalere Health. Copays are the portion of the cost of each prescription that the customer pays the pharmacy.

Avalere, a data analysis company that serves industry and government, said its findings show that Medicare prescription plans are steadily shifting costs to chronically ill patients who need more expensive kinds of medications. At the same time, the plans are trying to keep costs in check for the majority whose conditions can be managed with less-expensive generics.


The changing scene underscores how important it is for seniors to check their prescription coverage before open enrollment ends Dec. 7.

Medicare announced this summer that premiums for prescription plans would remain unchanged next year, an average of about $30 a month. But the government’s numbers didn’t delve into detail on copays. The Avalere study shows that the plan with the lowest monthly premium may not always be the best deal.

“Seniors need to look beyond the premium to understand their drug benefit,’’ said Avalere chief executive Dan Mendelson. “The more the cost burden gets shifted onto the patient who needs the medication, the more important it is for seniors to understand that next level.’’

Medicare officials took issue with the study, saying broad averages of prices charged by drug plans don’t determine what an individual beneficiary will end up paying.

“Everyone’s drug needs are going to be individual,’’ said Medicare deputy administrator Jonathan Blum. “You can’t make a general conclusion until you look at the particular plan they are in and the particular drugs they are taking.’’


Blum pointed out that President Obama’s health care overhaul law is saving money for beneficiaries with high drug costs, providing a 50 percent discount on brand-name drugs for those who fall into Medicare’s “doughnut hole’’ coverage gap.

The administration is highly sensitive to criticism of its stewardship of Medicare. After Obama’s health care law cut the program to finance coverage for the uninsured, many seniors responded by voting for Republicans in the 2010 congressional elections.

Medicare covers about 47 million seniors and disabled people, and about 9 in 10 beneficiaries have some kind of prescription drug plan. Most rely on the prescription program, also known as Part D, which is delivered through private insurance plans.