The latest “big idea” from DC and CMS was intended to lower prescription drug costs. So far there is no proof that the prescription copays will be lower, and in fact, many medications are much costlier in 2024 vs last year.
It is too early to know what 2025 will bring but sources point to . . .
- Fewer drug plans
- Higher deductibles
- Higher premiums
- Tier shifting
- Higher copays
- Fewer drugs (especially the high priced ones) on formulary
In addition to this, pharmacies are closing almost weekly.
https://www.gpb.org/news/2024/05/10/independent-pharmacists-cry-foul-at-kemp-veto
A bigger problem is one that will only get worse going forward and CMS has no intention to correct it.
Small, independent pharmacists can’t keep brand name prescriptions in stock because they are being diverted to the national chains like CVS, Walmart & Kroger.
The life-saving medication you need may not be available when it is due for a refill if
you use a family owned, independent pharmacy. This problem is worse in rural areas.
Everywhere pharmacies are laying off staff and closing stores. Their profits are squeezed to the point they can barely keep their doors open.
https://www.drugs.com/drug-shortages/
Meanwhile, CMS shrugs and says that is not their problem . . .
“We cannot interfere in the negotiations that occur between the plans and pharmacy benefits managers,” Meena Seshamani, director of the Center for Medicare, said at a conference on June 7. “We cannot tell a plan how much to pay a pharmacy or a PBM.”
CMS had no problem telling carriers and providers what they HAD to do when Obamacare rolled out . . . but now they wash their hands and say it is not their problem.
Nevertheless, CMS has reminded insurers and PBMs in several letters that they are required to provide
the drugs and other benefits promised to beneficiaries.
Not . . . their . . . problem. Of all the nerve!
NOTE: Announcements originating in DC are always billed as
“improvements” that will “lower costs”. Caveat emptor, there is almost always a discrepancy in what is promised vs reality.
Hopkins, in Sacramento, said that some of his newer customers used to rely on a local grocery pharmacy but came to his store after they could no longer get their medications there.
The crux of the problem is cash flow
Some pharmacies don’t generate enough revenue to stock high demand drugs because they are being squeezed by government rules.
Kavanaugh Pharmacy in Little Rock, Arkansas, no longer accepts Cigna and Wellcare Medicare drug plans,
Your drug plan can be used anywhere . . . unless the pharmacy refuses to accept it . . . which is within their
right!
Cigna and CVS/Aetna control half of the prescription drug retail market.
https://kffhealthnews.org/news/article/biden-medicare-dir-fees-reform-pharmacy-cash-flow
From this point forward, the consumer cannot rely solely on their drug
plan to pay for their medications. There are several ways around this government bureaucracy manufactured problem.
- Pay cash and use discount cards like GoodRx and SingleCare
- Buy generics when possible
- Use mail order like Capsule, Amazon, Cost Plus and more . . .
- Ask your doctor about using some of the established medications in place of the high priced, newest medication.
- Look at Canadian
pharmacies
There are a number of ways to maintain your health as long as you are willing to consider other avenues.
