Flash finding: Plan Finder leaves seniors hanging in their search for cheap prescription drugs
One of the occupational hazards that comes along with our research is having to spend lots of time using Medicare Plan Finder. This was especially the case for our latest deep dive into the warped incentives in Medicare Part D to prefer high cost specialty brands over their cheaper generic equivalents. Plan Finder has its critics. Sharing that we are among them is not worthy of a Flash Finding. But what is worthy is a case study we compiled while we were deep in one of our many Copaxone-report rabbit holes. It’s quite a disconcerting example, as it suggests that the primary tool used by seniors to find drug coverage cannot actually help them find the cheapest drugs.
What we found
6,242 words (if you were counting) into our latest drug pricing tome on Copaxone coverage and pricing in Medicare Part D, we presented the following figure comparing Copaxone coverage and pricing across 10 of the largest Part D Plan Sponsors. There’s all sorts of information in this table that’s interesting to researchers and policy folks, but only one number that really matters if you are the patient – the tier on which plans have placed the drug. If it’s on Tier 5, brace yourself, because you’re likely going to be shelling out 25-30% of the plan’s inflated drug cost. For Copaxone or its generic equivalent, glatiramer, your annual cost will (at best) run into the thousands of dollars. But what if your plan placed it on Tier 2? Your share of the overall cost precipitously drops to just $10-20 per prescription! As you can see in Figure 1, there is only one plan sponsor that has, for all of its plans, placed glatiramer on Tier 2 – Kaiser Permanente.
Figure 1
Source: CMS.gov, 46brooklyn Research
What we found when we dug deeper
We ventured over to Plan Finder to confirm these findings. From a patient’s perspective, the contrast between Kaiser and a “normal” Part D plan is staggering for a drug like glatiramer. Figure 2 shows four screen shots taken from Medicare Plan Finder for plans offered in Los Angeles. We simply entered one drug (generic glatiramer), told it our pharmacy of choice, and collected screenshots showing us the cheapest plans. Note that all four plans have no monthly premium, so we can compare apples-to-apples on drug costs.
Figure 2
Source: CMS Medicare Plan Finder
Note: All pharmacies shown are within 5 miles of zip code 90047
When we chose a Kaiser pharmacy, a Kaiser plan came up (they are fully integrated, so this makes sense) with an all-in drug cost for generic glatiramer of only $75 over the next four months. The problem is that if we hadn’t known about Kaiser’s insanely low copay pricing already (which took a lot of SQL code to figure out, something we assume an average senior is not doing), we wouldn’t have found this plan.
That’s because Medicare Plan Finder makes the user select a pharmacy first before it displays drug costs. But how would we know we need to select a Kaiser pharmacy if we are not already with their plan? Chicken, meet egg. Instead, our seniors are more likely to just key in their current pharmacy, say a Walgreens, CVS, or Rite Aid, and get hit with drug costs ranging from $1,581 to $2,281 over the same period, and that’s for the lowest cost plan at these chosen pharmacies!
FWIW
Let’s start with the good news. At least our digging through Plan Finder confirmed that there is at least one company in this country that, despite the incentives to do the opposite, has somehow figured out how to price an expensive specialty drug like a cheap generic for its patients. But the bad news is that the primary tool provided to seniors to find drug coverage makes it really difficult for them to figure this out.
Simply put, it needs to be easier for patients to find the least costly plans for their drugs on Medicare Plan Finder. CMS somehow needs to figure out how to display plan drug costs before our seniors are asked to choose a pharmacy. The way it’s designed today makes it exceedingly difficult for anyone to know if they can save significant money on their drugs by switching both plans and pharmacies.
For those looking for a PDF version of last week’s report, we now have one available here.
Thanks to Rhiannon Meyers Collette at Arnold Ventures for her excellent synopsis of last week’s Medicare Part D Copaxone report. If you can believe it, we were told by a few folks that 6,000+ words for a report on the intricacies of Medicare Part D drug coverage might be a bit long. Bravo to Rhiannon for keeping it lean and mean!
Additional thanks to John Wilkerson over at Inside Health Policy for his concise write-up on our Copaxone findings. John continues to be a national leader in making the complicated nuances of the U.S. drug pricing system accessible to laypeople.