- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Medicare Beneficiaires May Struggle with Web Enrollment
Finding a health plan on the Medicare website could be troublesome for some seniors.
Finding a health plan on the Medicare website could be troublesome for some seniors. According to Gina Upchurch, executive director of Senior PharmAssist, a nonprofit group in North Carolina, a plan finder tool on the government’s website is showing higher prices for a prescription filled every 2 or 3 months compared with the same drug bought every month under 2014 drug policies. “You’re buying less and paying more,” she said.
Prescriptions such as eye drops, creams, or inhalers can last for more than a month, yet some insurers cap discounting for prescription drugs other than for 30-day regimens. Dr Upchurch found one plan that charged a beneficiary with a monthly prescription for eye drops $7 a month during the initial coverage period to get the drug, while another person who has a prescription for the drops to be filled every 60 days would pay $51. Another 2 plans she compared charge $40 or $45 for 3 vials of insulin every month in the initial coverage period, and $575 every 2 months.
Fred Riccardi, director of client services at the Medicare Rights Center, says elderly patients should call their insurers to seek out alternative plan options that might reduce costs, such as ordering through the mail order pharmacy. However, Dr Upchurch argues, “People shouldn’t have to run around to different pharmacies” and that “It would be better if Medicare required plans to cover whatever supply a provider prescribes.”
Elderly beneficiaries may encounter additional barriers to affordable healthcare due to their lack of access to the Internet. A study released in September by the Pew Internet & American Life Project found that a disproportionate amount of older Americans do not use the Internet. Kathryn Zickuhr, who wrote the Pew study, found 49% of non-Internet users are older than 65 years.
Around the Web
Strange Pricing Details Can Bedevil Medicare Beneficiaries [Kaiser Health News]
Gap Between Those Who Use Internet and Those Who Don’t is Widening
Comparing Breast Cancer Treatment Outcomes Between Fee-for-Service and Medicare Advantage
April 4th 2025This study examined postdiagnosis breast cancer treatment outcomes for Medicare Advantage vs fee-for-service (FFS) Medicare in Ohio and found no significant differences overall but disparities for Black patients with FFS Medicare.
Read More
Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
Listen
How Recent Federal Policy Changes Are Shaping Managed Care Pharmacy
April 2nd 2025Federal legislative and regulatory changes are reshaping pharmacy practice, with key challenges in government funding, pharmacy benefit manager reform, and health care policy shifts—topics explored by experts at the Academy of Managed Care Pharmacy's annual meeting.
Read More
