New York Estate Planning & Elder Law Blog
A recent article by The Washington Post put a spotlight on the difficult healthcare choices many seniors must make when it comes expensive specialty drugs that appear to be going up higher and higher in price without any end in sight. For many seniors like the couple featured in the article, these specialty drugs are having a tremendously negative impact on the finances of retirees living on fixed incomes trying to balance a healthy and comfortable life.
The report centers around a now 66-year old retiree taking Betaseron, a drug that helps prevent flare-ups from multiple sclerosis. While she had health insurance through her job, she was used to paying anywhere from $50 to $100 for a month’s prescription, never knowing the list price of the drug came out to a staggering $86,000 for a year’s supply of the drug.
Even through prescription drug plans from Medicare, she still faced an enormous $7,000 in our of pocket expenses per year. Sadly, faced with paying thousands out money saved for retirement, she decided to cease taking the drug altogether to ensure her and her husband had enough money to make it through retirement.
The story is an all too common issue plaguing many seniors who take these types of expensive specialty drugs, which have to caps on out of pocket expenses. Furthermore, Medicare offers many different types of prescription drug plans that end up forcing many into the “catastrophic phase” of their coverage where they only pay 5 percent of the drug’s list price.
According to the report, the number of seniors in the catastrophic phase of their insurance plans has almost doubled over the past four years, putting additional strain on an already imperfect system. An analysis by the Kaiser Family Foundation estimates more than 1 million individuals entered this phase of their coverage in 2015.
Although the Affordable Care Act tried to close the “doughnut hole” where Medicare coverage ends and the catastrophic phase begins, many seniors find that just a one or two month’s supply of their prescriptions can put them over the limit. Unless lawmakers take steps to increase transparency and begin to take into account the discounts many insurance companies receive, the number of seniors struggling to balance their health and finances will continue to rise to rise to unprecedented levels that our nation simply cannot tolerate.