Part D Brand Co-pays on the Rise

Rising costs for brand-name medications and deductibles mean that seniors need to do their homework--and pharmacists need to be prepared for angry patients.

Look out seniors, 2012 will be a year of increased prescription expenses if you have a Medicare Part D prescription plan and take any brand name medications. Those co-pays are set to increase dramatically and some seniors may be caught off guard. Changes in Part D plans coming on January 1 of next year may increase out-of-pocket expenses for some seniors.

Seniors are in that open enrollment period for Medicare Part D plans for next year. The annual enrollment or re-election period for Medicare Part D plans runs from October 15th through December 7th for the 2012 plan year. Seniors have that window of opportunity to change plans if they wish. And this year it is more important than ever for them to review their options.

But what will the New Year bring to those people covered under a Part D plan? Well, here is a nice chart from Q1Group LLC not only explaining the details of how Part D plans will work starting in 2012, but also comparing next year’s numbers to previous years. It looks like expenses will go up in general for seniors unless they are fortunate enough to require only generic medications.

The APhA also has a nice article highlighting some of the changes coming in Part D plans starting in the New Year. It highlights the fact that medication therapy management (MTM) services appear for the first time in the new Medicare handbook. I would caution being overly optimistic about the new mention of these pharmacist driven clinical services being covered by Medicare. The wording in the official Medicare handbook seems quite vague and seniors must review their specific plan details to see if such services are actually covered or not.

But MTM services aside, one thing looks certain. If you are a senior covered under a Medicare Part D prescription benefit plan and you take brand name medications, your co-pays are set to dramatically rise starting 1/1/12. Yahoo News reported this Associated Press story ( that warns of increased co-payments for brand name medications starting next year. Out-of-pocket expenses for brand name medications could be rising by as much as 40% for some seniors.

Those increases in costs for seniors can add up. According to the AP story, even a preferred brand name medication under the 2012 Part D plans could cost seniors an average of $40 a month. And non-preferred brand name drugs could shoot up to average over $90 (an increase of $20 over the 2011 average expense). Couple that with a rising deductible ($320 in 2012 vs $310 this year) and an increase in the ceiling needed to get past the donut hole ($4700 in 2012 vs $4550 this year) and seniors could be spending hundreds more in 2012 for their medications.

So what is the bright side for seniors on a budget? Well it appears that generic co-pays will either hold steady or even decrease slightly next year. Couple that with a barrage of new medications losing patent and having lower cost generics available, and some seniors may find their total medication expenses actually decreasing in 2012. But pharmacists should warn seniors that the devil is in the details of their specific coverage plans.

So what does this mean for seniors going into the end of 2011? In a few words: do your homework. Find out what plans are offering what co-pays for the medications you take individually (brand or generic) and make an educated decision on which plan to carry for next year. The difference between plans may save (or cost) you hundreds of dollars or more in out of pocket expenses over the course of an entire year. It is well worth your time to study all of your options and go from there before locking yourself into a Part D plan for 2012.

As for pharmacists, be prepared for angry and confused patients starting January 1st. These co-pay increases might just catch some seniors off guard and they will inevitably ask the pharmacy staff why they are paying more for their medications. The burden of cost is further shifting from plan providers to patients. And seniors will see this trend continue in 2012. e prepared everyone, 2012 could mean higher prices at the pharmacy counter for seniors. I hope everyone is ready!