Patients have options to save on drug prescriptions

Nov. 01--After some tweaking, a plan to reduce drug costs for Medicare Part D recipients may be less of a cut than initially anticipated.

The federal budget deal passed in February required the pharmaceutical industry to pick up $11.8 billion in Medicare drug costs over 10 years to close a gap in prescription coverage. The companies now want that number reduced by $4 billion, thanks to reworked numbers that account for new data.

The pharma lobby says the $4 billion windfall is justified because the Congressional Budget Office estimated the measure would save $7.7 billion over 10 years in prescription costs for seniors, but after the law went into effect the CBO revised its findings and changed the estimate to $11.8 billion in savings.

Adjusting the bill for drug manufacturers will result in many Medicare D beneficiaries continuing with what they do anyway, along with the rest of the public: Looking for savings on prescriptions.

"Using generics is one obvious step," said Dr. Matt Lee of Tahlequah Drug Company. "People need to figure out which drugs are covered by their insurance plans. There are several different cholesterol medications, and an insurance plan will cover some of them, but not all. If a drug is not covered, you might have a conversation with your doctor and see if the prescription can be changed."

Lee said pharmacies sometimes change drugs on behalf of the patient to avoid ordering too much of a drug many patients cannot afford and refuse to purchase.

"With the new Medicare plans coming out, a person needs to make sure an insurance plan is economical," Lee said. "Some have a deductible to meet, and the premiums are less. But if you can't afford to pay full price until the deductible kicks in, that plan may not be for you. Others have no deductible but the premiums are higher."

Dr. Sarah Wyssmann of Cox Drug said patients should consult with health professionals about medication options.

"You can talk with a doctor of pharmacist about a possible drug change," Wyssmann said. "Usually, something can be found for the patient that is a little more reasonable. Understand that if there is a problem, when we have to reach out to the doctor or the insurance company, it may take some time. With the paperwork required from a lot of insurance companies, it may take longer than 24 hours. I know that can be frustrating, but maybe we can find a prescription that saves the patient some money."

There are also prescription cards, such as GoodRx. Patients should consult their pharmacies to determine which cards are accepted before signing up.

Lee said Tahlequah Drug Company does not accept GoodRx.

"We have decided not to accept discount cards, the reason being they are obtained on the internet or through a mailer, and they charge us a fee to use that discount card," Lee said. "Then they do arbitrary price cuts. Most of our generics are priced as low as we can go. At a large pharmacy like Walmart, the cards might be a good option. Honestly, prescription cards haven't been a big deal for us, because between private companies, SoonerCare or Medicaid, Medicare and the Cherokee Nation, almost all of our customers have insurance."

Conversely, GoodRx is accepted by Cox Drug.

"For insured and uninsured patients there are manufacturer coupons or free discount cards like GoodRx, and they can help," Wyssmann said. "If you are a patient with NeoHealth, they have special drug pricing. If a patient is on very expensive medicines -- brand names in particular -- NeoHealth has discounts. Their doctors have to write those prescriptions and you have to visit one of the approved pharmacies. They will have a list of those."

In Washington, D.C., those supporting the relief for pharmaceutical companies reportedly include U.S. House Speaker Paul Ryan, U.S. Senate Majority Leader Kevin McCarthy, Energy and Commerce chair Greg Walden and Senate Minority Leader Chuck Schumer. Some pundits and aides believe the "refund" has a respectable chance of passage, perhaps during the final session of the 115th Congress, which will include some lame duck members after the midterm elections.

It may surprise some that there is a degree of bipartisan support, and some industry observers say the incentive isn't necessarily due to Big Pharma buying votes. Drug companies have facilities in red and blue regions, meaning lawmakers of both parties have pharmaceutical jobs in their states and districts.

The February budget item was intended to address the "doughnut hole" in Medicare drug coverage. Pharma companies were to provide bigger price reductions to Medicare recipients whose outlays for prescriptions fall within the "hole." A 50 percent price reduction on brand-name prescriptions was to increase to 70 percent in 2019.

Various angles of attack can be used for lobbying. The Pharmaceutical Research and Manufacturers of America contends that insurance companies have no incentive to negotiate drug prices under current policy. PhRMA wants insurance companies to pay more for drugs, claiming it will force insurers to find the best prices for older patients. PhRMA has spent more than $500,000 on campaign contributions during the current election cycle.

A message left with Dr. Jason Mutz of Reasor's Pharmacy in Tahlequah was not returned. Staff said Mutz had a long line of patients awaiting flu vaccinations.

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