Restricted Availability for Some Part D Medications

somarco

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The Inflation Reduction Act signed by President Biden in 2022 somewhat limits how much retirees will pay out of their own pockets for medications this year. Next year, the law imposes a hard cap of $2,000.

But while retirees are getting a reprieve from Congress, insurance companies are pushing in the opposite direction.

According to research appearing in Health Affairs, insurers are tightening retirees’ access to some medications and increasing the number that are excluded from Part D and Medicare Advantage plan coverage altogether.

Ultimately, this might either cost retirees more or, in the most extreme cases, prevent them from taking some necessary medications if they can’t afford to pay the cost themselves.



Unintended consequences when politicians are allowed to legislate health care.
 
The Inflation Reduction Act signed by President Biden in 2022 somewhat limits how much retirees will pay out of their own pockets for medications this year. Next year, the law imposes a hard cap of $2,000.

But while retirees are getting a reprieve from Congress, insurance companies are pushing in the opposite direction.

According to research appearing in Health Affairs, insurers are tightening retirees’ access to some medications and increasing the number that are excluded from Part D and Medicare Advantage plan coverage altogether.

Ultimately, this might either cost retirees more or, in the most extreme cases, prevent them from taking some necessary medications if they can’t afford to pay the cost themselves.



Unintended consequences when politicians are allowed to legislate health care.

And there will be those who trash the insurance company for this. I mean, why shouldn't the insurance company just eat the losses? I believe this is all part of the strategy. Overwhelm the system and then swoop in with a solution (control) to the problem you created.

I think the most entertaining phone calls I have are the ones who call about dental insurance because they just left the dentist and they need $6,000 of dental work done. They are then upset when I tell them there isn't a plan that will pay for that (although UHC now has one). I simply give them a scenario to help them better understand.

"You don't try and get auto insurance AFTER the car accident or homeowners insurance AFTER the fire. Same goes for dental insurance. You really can't expect to pay an insurance company $50 and then expect them to pay thousands in claims."
 
And there will be those who trash the insurance company for this.

Some already have on another forum.

There is much to blame the drug manufacturer, the PBM and the carriers for but this one falls flatly at the feet of those in Congress who passed a bill that had nothing to do with reducing inflation and everything to do with buying votes in certain areas of the country.

The inappropriately named Inflation Reduction Act is projected to cost taxpayers $800 BILLION over the next 10 years.

A billion here, a billion there . . . eventually you are talking about a lot of money.
 
I found this part interesting:

"Interestingly, Medicare Advantage plans, which now dominate the market, have fewer restrictions than Part D plans. Because Advantage plans also cover medical treatments, the companies that sell them may have an interest in protecting policyholders’ health, since they face higher costs if patients are unable to take the preferred drugs their physicians have prescribed."
 
I found this part interesting:

"Interestingly, Medicare Advantage plans, which now dominate the market, have fewer restrictions than Part D plans. Because Advantage plans also cover medical treatments, the companies that sell them may have an interest in protecting policyholders’ health, since they face higher costs if patients are unable to take the preferred drugs their physicians have prescribed."

I’m only referring to Florida here, but MAPD plans have much better drug coverage than PDP plans. It’s not even close and it’ll probably grow next year.
 
I’m only referring to Florida here, but MAPD plans have much better drug coverage than PDP plans. It’s not even close and it’ll probably grow next year.
Agreed.

Looks better on the plan finder!

And it’s going to add to the 2025 chaos. MAPD can’t keep giving away the extras and lose money on Part D coverage without the RA upcoding and it just got demolished.
 
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