Medication Access in America and Medicare Part D: Prescription Shopping Saves but May Be Costly

Abstract

This article is a reflection of some of the changes we have witnessed in pharmacy over the years, including the rise in medication use and prices and the transformation of how medicines are paid for in the United States, with growing concern over pricing transparency. We discuss the complex Medicare Part D prescription drug benefit, how enrollees can save by comparing plans annually, and the influence of preferred pharmacies. We review options for medication assistance other than Part D and share our belief that, although Medicare Part D has dramatically improved access to medicines, more needs to be done to decrease Medicare's and individuals' out-of-pocket spending and, as importantly, to ensure that medicines are doing more good than harm. J Am Geriatr Soc 66:33-40, 2018.

The Health of Older Americans: A Primer on Medicare and a Local Perspective

“…For more details about the Part D benefit, see Medication Access in America and Medicare Part D: Prescription Shopping Saves but May Be Costly. 18 Individuals enrolled in MA plans replace Medicare Parts A and B with a private insurance policy that can include a Part D drug benefit (MA-PD). MA plans cover the same services that original Medicare covers, but the beneficiary pays for the services differently, usually in the form of copayments before receiving a service, although deductibles and coinsurance apply in some cases ( Table 2).…”

Cost‐Related Medication Nonadherence Among Older Adults: Findings From a Nationally Representative Sample

“…Medication nonadherence is a complex behavior that can manifest in multiple forms (eg, not following administrative instructions) and conveys substantial medical and economic consequences . Approximately 93.5 million Americans take at least one prescription medication, but they often do not take these drugs as prescribed, and nearly 30% of prescriptions are never filled by patients .…”

Senior PharmAssist: Less Hospital Use with Enrollment in an Innovative Community‐Based Program

“…There were 113 Medicare LIS applications completed for participants, 46 referrals made to Medicaid or Medicare Savings Programs, and 500 participants who switched stand‐alone Part D plans. Over the last 5 Medicare open enrollment periods, 55% to 68% of individuals enrolled in stand‐alone Part D plans switched plans for an average projected annual savings of $806 …”