by Marc Manor
There are many divisive social and political hot button issues but one I think most people would agree on is the issue of the high cost of prescription drugs in America. I believe Medicare is a great system but it falls woefully short when it comes to prescription drug coverage for higher cost drugs. Private insurance companies follow a model provided by Medicare but that is simply not enough. Sometimes I talk to people who take two or three high tier drugs and I can’t help but to feel somewhat angry about what they are having to deal with to maintain good health.
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I know I’m not the first person to bring this up, but I am piling on because I think that we all need to keep the pressure up on the government and the pharmaceutical companies to protest just how insane these costs really are. To illustrate just how ridiculous the price of prescription drugs can be, I created an example we will call “Joe”:
“Joe” has several ailments requiring some name brand prescription drugs. Joe, has an allergy to bee stings so he is required to have Epipen (injectable Epinephrine). Joe is diabetic and has been prescribed Farxiga® to control his glucose levels. Dry eye syndrome, has plagued Joe for years and he needs his Restasis® drops once a day to keep his eyes moist. Joe takes Xarelto® to keep his blood from clotting. These are all serious problems and Joe needs to have Epipen available at all times and the other drugs on a daily basis.
The table below, is an estimate of the full cost of Joe’s drugs:
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Epipen 2-PAK INJ 0.3MG
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$621.18
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Farxiga TAB 10MG
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$502.65
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Restasis EMU 0.05%
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$284.83
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Xarelto TAB 20MG
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$457.35
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TOTALS:
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$1,866.01
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Fortunately for Joe, he does not require the Epipen every month, so the total for all his drugs on a monthly basis would only be about $1244.83! These figures represent the full retail cost of these drugs at a typical retail pharmacy. If he has Medicare Prescription Drug coverage, Joe would have significant savings, but he would still likely have a monthly out-of-pocket expense of more than $100 per month during his “initial coverage” stage under Medicare. Because the Medicare Coverage Gap (donut hole) is calculated on the full cost of the drug and his entry into the Coverage Gap is $3820 (in 2019), he will probably reach the Coverage Gap in the fourth month. Rumors were circulating for several years that the Coverage Gap was going away in 2019 but as we all know…that did not happen and there is no end in sight (I'll save the rant about the Coverage Gap/Donut Hole for another blog).
This is a fairly extreme example; but, it is not all that unusual for people to have similar expenses on their prescription drugs. Insurance and pharmacy discount programs can help, but even with insurance coverage, it is the cost of the drugs and the Coverage Gap rules that can really put the financial pinch on consumers.
Going mail-order to Canada or other countries is generally not advised, but people do it because they are desperate for some financial relief. Congress asked a number of Pharmaceutical company representatives to testify in January of 2019 but to date, legislation has not been passed to put some controls on drug pricing.
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We all need to keep the pressure on our legislators if we ever expect these prices and coverage to be reasonable. You can contact your Representative by using the House of Representatives site: https://www.house.gov/representatives/find-your-representative.
Your Senator can be reached through: https://www.senate.gov/senators/How_to_correspond_senators.htm.
I highly encourage everyone, regardless of age or medical condition to reach out to your legislators on this important bi-partisan issue. Without our push, I fear we will continue to deal with drug prices out of control. After all, even if you don’t take any prescription drugs, you likely know someone who does or you may need this relief at some time in the future.
Your Senator can be reached through: https://www.senate.gov/senators/How_to_correspond_senators.htm.
I highly encourage everyone, regardless of age or medical condition to reach out to your legislators on this important bi-partisan issue. Without our push, I fear we will continue to deal with drug prices out of control. After all, even if you don’t take any prescription drugs, you likely know someone who does or you may need this relief at some time in the future.
Marc Manor is a 30-year military veteran who is now dedicated to teaching his
fellow Americans how to make the most of their Medicare and Supplemental Insurance benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.
Since drug companies has a monopoly on patent drugs, we as a consuming public have little or not control as to the prices they charge. This has allowed them to gouge us in many instances. We do need the government to step in and stop these practices.
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