Guest Editorial |

Guest Editorial

On Jan. 1, 2006 I joined AARP’s much-heralded Medicare Drug Plan D with trepidation and anxiety. No AARP member had any personal experience with what had been concocted by the pharmaceutical industry and endorsed by the AARP (speaking of unholy alliances!). I did know that my drug costs, which were reported on my 2005 IRS form, totaled $2,250.

Let me say at the outset that for the first six months, I was pleased with my plan — no deductible, and the monthly premium was $30. For my most expensive drugs, I was charged only about $25 each for a month’s supply of Advair, Zoloft, Zocor and Singular, all four being so-called Tier 2 (or middle co-pay) drugs. The standard cost for these brand-name drugs, respectively, was $158, $117, $150 and $94. Thus my average saving during this initial coverage period for each of these drugs was $130 minus $25 = $105.

My rude awakening occurred June 15 in a letter from AARP Medicare Rx Plan, with an updated account of my personal and the plan’s payments toward my initial coverage. I was reminded that once this limit was reached, my payments would count toward my coverage gap (sweetly dubbed "donut hole"). Once the gap was paid, I would qualify for the so-called "catastrophic coverage." In simple terms, the initial and catastrophic coverage are desirable because of the bargain costs we pay. On the other hand, the coverage gap period is decidedly undesirable because we pay through the nose. (One has to take off his hat to the mathematician working behind the scenes, who created the amounts and length of the various coverage periods.)

Dec. 8 has become one of my favorite dates because when I went to pay for a refill of Advair, I was told that with that expenditure, I now qualified for catastrophic coverage. She promptly filled my prescription and another unsolicited one of my big four medications, Singulair). In contrast to the $149.47 I paid for my Advair, I paid just $5 for the Singulair refill. It was as if the pharmacist wanted to make amends for charging me top dollar during the coverage gap, and only a pittance during the catastrophic coverage period.

So what is the bottom line for my personal out-of-pocket drug costs for 2006 under Plan D? I couldn’t wait to see the figure my calculator came up with — $3,380, with three weeks to go, compared to what I paid last year — $2250.

I must admit that my Salt Lake City internist has been saving me a considerable amount of money for years by giving me complimentary samples whenever I went for check-ups, the total amount easily wiping out the $1,100 difference I paid overall this year. Interestingly and pointedly, suddenly this year the various drug companies who distributed samples to my internist last year, who in turn passed on the freebies to me, stopped their practice of leaving samples with him (and I’m sure with many other physicians). It seems obvious that the drug companies are in cahoots with and work closely with AARP! Another factor, which must be thrown into the equation, is that this year a new and expensive inhalant was added to my regimen, Spiriva, which added to my total drug costs this year. Nevertheless, even considering Spiriva, I still believe I paid little more for Plan D, if any, than my former plan.

Finally, discriminating seniors, regardless of the Medicare drug plan they belong to, would be wise to check aggressive pharmacies — for example, Wal-Mart — who publicize $4 programs for a 30-day supply of generic drugs.

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