KosAbility: Using Medicare Part D prescription insurance can cost more than retail!

Charges for 3 months of generic Gleevec, by the least costly of 26 mail order pharmacy plans.

I spot checked the published retail cost of four different medications versus what you would pay when using Medicare Part D Drug insurance policies. Where generics are available, Mark Cuban's Cost Plus Drugs seems to have the cheapest published pricing, in this case for Gleevec and Invokana. For other retail pricing I used GoodRx. For part D insurance medication costs I used the Medicare site. I included the monthly part D premium and the annual deductible, divided by 12, in the monthly Part D medication cost. I chose mail order pharmacy for my Pharmacy.  I was eligible for a total of 26 mail order plans in my location. I chose the medications arbitrarily.

Medicare Part D Monthly Medication Costs 2023
Brand Name	Generic name	Indication	Dosage	Pills / month	Lowest Retail cost, $	Part D lowest cost, $	Part D 10th cheapest of 26, $	Part D  less than retail, % of plans	Part D lowest cost insurer
Gleevec	Imanitib	Cancer	100 mg	30	13	194	795	0%	AARP MedicareRx Preferred (PDP)
Rytary	Carbidopa/Levodopa*	Parkinson's	23.75 mg / 95 mg	90	384	271	395	38%	AARP MedicareRx Preferred (PDP)
Eliquis	Apixaban	Blood Thinner	5 mg	60	553	110	267	100%	Wellcare Medicare Rx Value Plus (PDP)
Invokana	Canagliflozin	Type 2 Diabetes	100 mg	30	246	121	430	19%	Cigna Extra Rx (PDP)

Note that the lowest cost insurer for different medications may differ from one medication to another, so if you're taking more than one medication, you my not find the lowest price on both from any particular insurer. You may be charged more than retail for one even though you may pay less for another. If you pay for more than one medication the monthly premium and annual deductible are shared, which provides some savings. In any case, the moral of the story is check retail pricing before you buy.

*Note on Rytary - carbidopa/ levodopa  can be had much cheaper. Rytary is a unique time release version.

Detail on charges using Gleevec example:

Click here to embiggen. Note that the $213 figure at top of the image is the sum of the October through December monthly drug costs at the bottom. The estimated Total Drug Plus Premium cost includes the monthly premium of $122. If we add that monthly premium to the monthly drug cost of $71  we come up with $194 per month, 1/3 of $580, which is what is shown in the spreadsheet above.

Part D prescription drug insurance also comes bundled with Medicare Advantage Part C if you choose to go that route.  I spot checked the same medications and got results very similar to what I found above for the part D plans.

The donut hole still applies to Part D and can add an additional costs. What Medicare has to say about it:

Once you and your plan have spent $4,660 on covered drugs in 2023, you're in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.

Also:

Once you and your plan spend $4,660 combined on drugs (including deductible) in 2023, you’ll pay no more than 25% of the cost* for prescription drugs until your out-of-pocket spending is $7,400 in 2023 under the standard drug benefit.

*I could not find any definition of “cost” in this context. Presumably it is some amount considerably greater than what you would be charged under a Part D plan.

For further discussion of the donut hole, this site seems to have a good explanation.

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