Feb. 04--Emil Conti's blood pressure was under control thanks to his daily use of the generic drug Verapamil, but it didn't get any help in January, when he saw his monthly co-payment for the drug rise from $8 to $105.
Conti, 83, of Lakewood, was taken aback. He thought he had done the things he needed to keep the cost low. Instead, he was going to have to reach deeper to pay for prescription drugs.
"I think it's ridiculous they raises prices like that," Conti said. "I didn't have any warning or anything."
Seniors each year can be hit with a spike in their prescription drug costs, mainly because of changes in their insurance plans that can be hard to find in the complex world of Medicare.
The unexpected cost is potentially another burden on seniors who, living on Social Security and retirement, can struggle to keep pace with inflation.
It has prompted experts to issue a red flag and encourage seniors and their families to talk to their doctors and pharmacists and visit a Medicare website each year to shop around for insurance plans.
"This wasn't the kind of issue they faced in younger years," said Elise Barry, chief executive officer of the New Jersey Pharmacists Association, a trade group in Princeton. "I think that's a concern, but it's also a reality that everyone has to face. We've all seen our personal health insurance contracts we get and they have 8 zillion pages of disclaimers. You try to ask the representative the questions that are meaningful to you. And you think you understood what they said. But I'm not even sure I understand."
Medicare provides health insurance for people age 65 and older. It helps cover hospital bills and doctors' visits. Seniors who have original Medicare instead of the managed care-style Medicare Advantage also can buy prescription coverage through Medicare Part D, plans that are operated by private insurance companies.
Conti uses a generic drug that he buys through Optum RX, a mail-order pharmacy -- two steps that can lower the cost.
"I went to order the drug and asked, 'What does it cost?' They said, '$105.' I said, 'Whoa, whoa whoa,' " he said.
A spokesman for Optum said Conti is a member of a group that moved from one insurance carrier to UnitedHealthcare, the insurance company that operates Optum, within the past year.
Insurers have what's known as a formulary, a list of drugs and manufacturers that get preferred status and are less expensive. Conti's old carrier charged an $8 co-pay for his dose of Verapamill. His new carrier charged $105, the spokesman said.
Experts said other factors can contribute to unexpected price hikes. Maybe the doctor prescribes an extended release version of the original drug. Maybe patients have a deductible they need to meet before insurance will kick in. Maybe they find themselves in what's known as the doughnut hole, a gap between when a prescription plan reaches the maximum it will spend and when catastrophic coverage begins.
But they sympathized with Conti, noting that Medicare recipients are sent a ton of paperwork each year, but few have the time or energy to go through it.
"We see that a lot," Scott Hartung, president of Shore Benefits Brokerage in Allenhurst, said of Conti's sticker shock. "They get a renewal. It will list the co-pays for the coming years. But they get something almost like a phone book."
"You have to do the research yourself, looking through this phone book they give you," he said. "It's really very difficult."
Many seniors' pocketbooks are already squeezed by drug costs. Social Security recipients, for example, received a 1.7 percent cost of living increase this year. Separately, brand name and generic drugs widely used by Medicare beneficiaries rose on average 4.8 percent in 2009, according to a study released last year by AARP.
Hartung, however, said seniors aren't defenseless. They should visit www.medicare.gov, which provides a database in which beneficiaries can type in the drug and their local pharmacy and get a list of insurance plans and costs.
If the cost is too high, they can take the information to their doctor or pharmacist to see if there are other options -- either a similar, but less expensive drug, or a different prescription plan.
"Is there a product similar to that?" asked said Paul Reyes, a pharmacist for Express Scripts, a pharmacy benefit management company based in St. Louis. "At least once a year, the patient should be looking at their medication."
It's too late, at least this year, for Conti and others who have recently seen their drug costs soar. They won't have a chance to switch insurance plans until Medicare Part D's annual enrollment begins again in October.
Michael L. Diamond; 732-643-4038; email@example.com
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