Friday, October 14, 2022

My Annual Rant on Medicare Drug Pricing

By Herb Greenberg

If you want to know how broken the health care system is – and how outrageously crazy drug pricing is – look no further than Medicare drug plans...

If you're not 65, I'm sure you'll stop reading – and that's fine. I would, too. This doesn't apply to you.

But one day... it will! So if that's you, it still makes sense to read today's essay all the way through to the end.

At the risk of sounding like an old man yelling at you to get off my lawn... I rant about this every year on social media and, ever since I've been writing these essays, right here. Fair warning – I'm about to do it again...

Since turning 65, at open enrollment every year I go through this absurdly ridiculous exercise of going to and checking out what the very same plan I had one year will be the next.

And every year, I'm appalled... and I keep wondering: How do people who don't know what to do – or who are too intimidated by the process – navigate all this?

This doesn't get much press because most reporters and editors are too young...

But it deserves to be front and center because it's simply so egregious.

In the five years I've been on Medicare, the prices for the same half-dozen cocktail of meds I take keep spiraling to levels that sometimes make zero sense, especially since they're all generics.

And every year, I find a way around it – or at least to mitigate it through my own cobbled-together hack that I'll share with you in a moment.

But doing so takes time and ultimately involves some level of inconvenience.

And before we go further, lest you think I'm a penny pincher...

I'm not talking about saving a few dollars, I'm talking about saving – in some cases – hundreds of dollars. As they say, even if you can afford it... it's the principle.

Which gets us to what's going on this year...

If you're on regular Medicare as I am – not Medicare Advantage – the process starts by going to the MyMedicare site, which to be fair has been improving. Or let's just say, it doesn't have that "government" feel, such as, say, the bare-bones, throwback-to-another-era Treasury Direct site.

You put in whatever drugs you take regularly or might get occasionally... and then whatever pharmacies you use, including mail order.

The site spits out a bunch of options, all priced from cheapest to most expensive, based on drug prices and premiums under each plan.

Like all insurance, the higher the premiums, the lower the drug pricing, and vice versa. Obviously, if you take a cocktail like I do, you focus on drug pricing over the premium, with the goal of finding something that balances out to your advantage.

That's where this gets tricky, and why I get so incensed...

Last year, like every year until this year, there's always a loss leader in the bunch – one whose prices were considerably cheaper than the other options in the same plan. Last year, it was a local independent pharmacy that I tossed into the mix on a lark, figuring it would be the highest.

Turns out, it was the lowest... and by a huge amount. I have no idea why, but I chose it because it made sense. That's typically the way it has been.

This year, under that same plan, that cheap local pharmacy became the most expensive... and not by a small amount.

Here are the numbers...

This year, my annual premium is $367. No complaints.

Better yet, the total bill for the cheap local pharmacy, based on the Medicare website, was predicted to be $1,464. That compares with more than $2,000 at Costco (COST), the national chains, and mail order – all within a few dollars of one another.

This year? I head over to MyMedicare and... yowza!

The premium has dropped by a few dollars, and overall pricing for Costco, CVS (CVS), and mail order were in line... while Rite-Aid (RAD) and that cheap local pharmacy soared. But it was the local pharmacy that made my jaw drop – prices under the same plan as last year skyrocketed by 135%. That's nuts.

But it gets nuttier than that...

The "cheaper" plans at Costco, CVS, and mail order are in theory cheaper because they're "preferred" vendors, as opposed to the others, which are merely "in network."

But even at those preferred vendors, while the overall annual price for my cocktail rose a mere 7%, some of the drugs within that group inexplicably shot higher.

Take irbesartan – a medication for blood pressure. It more than tripled to $179 per year from $58 per year. Or metoprolol, a lowly beta blocker I started taking after my heart surgery to keep my heart rate consistent – up 167%.

Meanwhile, rosuvastatin, better known as Crestor, fell by half.

All of that makes zero sense.

Which gets to my hack, if you can call it that...

I start by running all my drugs through GoodRx (GDRX), which I wrote about a year ago – back when its stock was nearly 10 times higher than it is today. I started doing it last year, and I also check HealthWarehouse and Mark Cuban's Cost Plus Drug Company, which have both tended to be slightly higher and somewhat more limited in selection.

Here's what I found...

The new version of this year's plan would charge me $180 for irbesartan. I checked GoodRx, and it showed that the retail price at Walmart (WMT) is $96 for the year – roughly half the price.

Another blood pressure pill I take is eplerenone... I had been paying $212 per year. Under the new plan, it's about $1,000 everywhere. With GoodRx, I can get it at Costco for $236. Another drug used to be $72... but under the new plan, it's $576. Buy it online at GoodRx, and I'd pay $132.

You get the picture.

There's no rhyme or reason... and it's out of control.

It always has been, and I'm guessing it always will be.

The drug lobby is simply too powerful. Ditto for pharmacy benefit managers, which are an opaque black box that runs the show.

The government's deal to allow Medicare to negotiate drug prices is a good start, but it's limited to only ultimately a few dozen drugs and, realistically, is years off.

My suggestion: If you have the time and/or inclination, do the cost comparisons. To me, it's like a puzzle and can be a great – albeit maddening – way to kill a few hours.

Of course, if you're like me, don't forget to take your blood pressure meds before you start.

As always, feel free to reach out via e-mail by clicking here. I look forward to hearing from you.


Herb Greenberg
October 14, 2022

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