While shopping for a new Part D plan this year, I noticed something unexpected. Using the medicare.gov comparison site, I put in my current list of medications to see the costs. Then I added a few extra drugs—just in case I might need them—to compare plans. One of the drugs was Eliquis, which is expensive.
To my surprise, the costs of the other drugs on my list went down when Eliquis was included. When I removed Eliquis, the prices for the cheaper drugs went back up. I tried this with a few other expensive drugs and saw the same pattern.
For example, a statin went from $0 to $75 when I took Eliquis off the list.
It seems like if you don’t have an expensive drug on your list, you end up paying more for the cheaper ones. Are the insurance companies saying, ‘If we can’t profit from pricey meds, we’ll charge you more for the cheap stuff’? Has anyone else noticed this?
It appears that if you don’t have an expensive drug on your list, you pay more for the cheaper ones. The insurance companies are saying ‘If we can’t make money off something pricey and profitable, we’re going to hit you for the cheap stuff.’
That’s not quite what’s happening. Eliquis is expensive enough to push you into a different phase of coverage. Medicare.gov assumes you’ll be filling that first, so it adjusts the cost of your other drugs based on the coverage phase.
When you remove Eliquis, you’re not spending enough to move out of the deductible phase, which is why the costs go back up.
This is a standard model that CMS created under Medicare’s rules, not a scheme by insurance companies.
Eliquis is expensive enough that filling it automatically pushes you into a different phase of coverage. Because of that, Medicare.gov assumes you’ll fill it first, which adjusts the pricing for your other meds.
Exactly, and the order in which you fill your prescriptions can make a big difference in what you pay.
For example, this year I was in the ‘Donut Hole’ and needed to fill two prescriptions, Jardiance and Tresiba. Both are pricey at retail. But Tresiba is capped at $35/month. If I filled Jardiance first, it would’ve cost me close to $500, with another $35 for Tresiba. However, filling Tresiba first, the system credited the full retail cost (over $3500), which immediately moved me to catastrophic coverage, making Jardiance free.
Pax said: @Hollis
Great point. Anyone using Part D insulin should make sure to fill that first before other prescriptions.
Yes, but I’m a bit torn for next year.
My Tresiba refill is due on Dec 23, and I have enough to wait until Jan 1. Should I:
Fill a 90-day supply on Dec 23 for free (since I’m still in catastrophic coverage), or
Wait until Jan 2, fill it first, and get credited for a significant amount toward the $2k OOP limit next year, even if it means paying $105 for the three-month supply.
@Hollis
If it’s okay to offer advice, I’d suggest filling it on Dec 23. It’s a life-saving medication, and it’s better to have it on hand in case something unexpected happens and you can’t get it on the second.
@Pax
That’s a fair point, but I have a buffer of a few weeks’ supply, so I won’t run out. I suppose I could also request a 30-day refill in December instead of the usual 90.
@Pax
Now that you explain it, it makes sense. I didn’t realize the Medicare site factors in deductibles when showing costs. I expected to do that math myself, like paying $100 until my deductible was met, then switching to copayments. I see now they’re doing the calculations based on assumptions of filling expensive drugs first.
I saw a video recently that explained this exact situation. It shows how drug lists can lead to different premiums and costs, sometimes in ways you wouldn’t expect. It even discusses how a plan with higher premiums could end up costing less overall.