Seniors can expect to pay more for prescription drugs than ever as Medicare shifts to a greater reliance on coinsurance, rather than co-payments.
A new study by Avalere Health finds that 58 percent of drugs offered by Medicare are subject to coinsurance. That is a dramatic shift in just the past two years. In 2014, only 35 percent required coinsurance, and in 2015 only 45 percent did.
Traditionally, it was only the highest-cost drugs that were paid via coinsurance, but it's quickly becoming the standard model for all types of medications that the nation's 55 million seniors depend on.
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Beneficiaries are never forced to pay more than 33 percent of the cost of a specialty drug. But considering how expensive some of these drugs have become, many seniors struggle to cover even a fraction of the cost.
The trend is not quite as pronounced for Medicare Advantage, the private sector alternative to traditional Medicare that an increasing number of seniors are opting for. Only 20 percent of drugs on Advantage plans are subject to coinsurance, the study found.
"As coinsurance becomes more common in Part D plans, consumers will find their drug costs are less predictable and will need to rely more on tools like the Medicare Plan Finder to help estimate out-of-pocket costs," said Colin Shannon, senior manager at Avalere.
Added Caroline Pearson, senior vice president at Avalere: "These very high rates of coinsurance have shifted our understanding of Part D formulary coverage. It will be important to monitor what drugs are being placed on various coinsurance tiers and how plans are using these tiers to manage cost and utilization in the program."
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