prescription drugs Archives

Federal Drug Rule Directs Insurers to Reveal What They Pay for Prescription Drugs

Prescription drugs have become so expensive that one in ten Americans opts not to get a prescription filled because of its cost. In an effort to help control the cost of prescription medications, the Trump administration issued a rule last year that will force health insurance companies to give customers estimated out-of-pocket costs for prescription drugs. Not only that, but insurance companies will also have to provide the negotiated prices that they pay for prescription drugs. The hope is that this will create more competition and help customers make better medical decisions that will save them money.

a crack in the ground dividing different colored groups — *There is a division between groups on whether it will drive costs down or disrupt the market.*

Division

There is some division among policy experts about how much this rule will actually save people; in fact, many groups who represent drug manufacturers argue it will decrease market competition and raise the prices of drugs. Commercial insurers and pharmacy benefit managers are also not in favor of the new rule.

“This rule will disrupt the marketplace dynamics and undermine the highly competitive negotiations that kept net prices for brand medicines at a growth rate of just 1.7% in 2019,” said Katie Koziara, a spokesperson for the Pharmaceutical Research and Manufacturers of America. She wouldn’t say whether her group would sue to block the rule.

But advocates for the new rule say it will help patients with private health plans save on prescription drugs. According to them, the rule will allow doctors to choose less expensive medications, and help health plans buy drugs more cheaply.

When the New Rule Goes Into Effect

These new drug price provisions are not estimated to go into effect until 2022 at the earliest. In 2022, private plans will have to publish online the prices that drug companies and benefit management companies negotiate with each other. And then, starting in 2024, insurance plan members will be able to request and receive estimates for out-of-pocket costs of medications.

The rule will not apply to Medicare or Medicaid. In addition, it will not require plans to disclose rebates and other discounts negotiated with drugmakers. That’s a disappointment to employers who provide health insurance for their workers. “We’d like a much clearer idea of how much we’re paying for every drug every time it’s dispensed,” said James Gelfand, senior vice president for health policy at the ERISA Industry Committee, which represents large self-insured employers. “We want to know where every cent in rebates and discounts is going. We’ll at least begin peeling back the onion. You have to start somewhere.”

The reason that manufacturers will not disclose the discount information is that other health plans will then ask for the same rebates. “Insurers and pharmacy benefit managers currently use rebates that are hidden from view to drive prices lower,” said Dr. Aaron Kesselheim, a professor of medicine at Harvard University who studies prescription drug policy. “If you make that transparent, you kind of reduce the main strategy payers have to lower drug prices.”

The Biden administration favors increased price transparency and therefore plans to keep the new price disclosure rule in place.

Medications Too Expensive? Let Us Help You Find A Better Plan

The price of medications has been steadily increasing over the years, and there is no sign that prices will be going down any time soon. Studies show that the prices of some top-selling brand-name medications, like insulin, have gone up over 50% in the last decade. These sharp increases in prices have left many people unable to afford the medications that they need, and have pushed thousands of people into seeking medications abroad. Purchasing prescription drugs from unknown sources can be dangerous, so instead of taking drastic measures, come to EZ.Insure. We will do our best to find you an affordable healthcare plan that includes the medications you need in a cheaper drug formulary tier.

different types of pills on a laptop screen — *Millions of Americans are buying medications abroad, but this can be very dangerous.*

Millions Seek Medications Abroad

It is no secret that millions of Americans are buying their medication from other countries. Drug prices are astronomical in the U.S., and there is no relief in sight. Your medications are necessary, but buying them abroad can be very dangerous, because these drugs can be the wrong dosage, contain different active ingredients from the drug prescribed to you, or even be completely fake. Taking these risky drugs could end up making your condition worse, or even killing you. There is a better way to get the medication that you need. At EZ, we believe that everyone should be able to access affordable medication. We can review the drug formulary that is part of your healthcare plan, and we can also help you find a plan that includes your medications in a lower tier.

What Are Drug Formularies?

Most health insurance plans include a drug formulary, which is a list of generic and brand-name prescription drugs, and how they are covered by your plan. Drugs are grouped into 4 different tiers, and these tiers determine the cost of each medication.

Tier 1 includes the lowest cost drugs, mostly generics
Tier 2 includes preferred (meaning that your insurance company prefers that providers prescribe these medications, because they costs less than others) brand-name and generic medications
Tier 3 includes non-preferred, higher-cost, mostly brand-name medications
Tier 4 includes specialty drugs, usually used to treat serious illnesses

Tier one drugs require the lowest co-payment because they are usually the cheaper, generic version of brand-name drugs. The higher the tier, the more expensive the medication. Most often if a drug is not covered, you can check with your doctor to see if there is another treatment option that is on your formulary. If there is no way to get your medication covered, or if it is on an unaffordable tier, EZ can help you find a plan that is better suited to your needs.

What EZ Can Do For You

EZ understands that you need affordable access to your medications, and we also understand how drug formularies work, so we can find the best plan for you. Drug tiers vary from insurance company to insurance company, so your drug might be covered differently by one company than it is by another. Your medications might even be classified differently under different plans offered by the same company! Sorting through each drug formulary can be a lot of work, so we will go over all of it with you. If you don’t currently have any health insurance, we can sign you up for a plan with a drug formulary that works for you.

If you have any questions about what is – and what is not – covered under your plan, you can contact your insurance company. And if you are not happy with the coverage you’re getting from your plan, EZ will help you find a plan that provides affordable coverage for your medications. There is no need to take a risk and buy your medications from other countries. EZ wants to make sure that you are safe and taking the proper medications, which is why one of our agents will go over your medical history, including what medications you need to take, and will find a plan that best suits your needs. All of our services are offered for free, because we just want the best for our customers. To search through all of our available plans and quotes for free, enter your zip code in the bar above, or if you want to speak to an agent, call 888-350-1890.

High Prescription Drug Costs Leave Many To Shop Abroad

Prescription drug prices have been soaring over the past decade, leaving millions of Americans unable to afford the medications that they need. If you have a great health insurance plan, then you have access to prescription drugs at a fair price; however, for many Americans, necessary medications are financially out of reach. Now, more than ever, as our country is being hit by a pandemic and a related financial crisis, Americans are looking for cheaper prescription drugs. All of this is forcing millions of Americans to shop abroad for their prescription drugs.

The Continuous Rise in Prices

Prescription drug prices continue to rise every year. A study published in JAMA, from 2012-2017 shows that insurer and out-of-pocket costs of 36 top-selling brand-name prescription drugs increased by more than 50%, and the cost of 16 of them more than doubled. Insulins such as Novolog, Lantus, and Humalog, and tumor necrosis factor inhibitors (Humira and Enbrel) were some of these high price increases. The reason these drug prices have been on the increase over the past year is because they are biologics, meaning they are made of large, more complex compounds which makes it hard to make generic brands of them. Not to mention, these are highly used medications within the U.S.

Overall, the median cost of the drugs included in the study increased 76%. This year, medication costs are going up an average of 5.2%, which will make many drugs unaffordable for the majority of Americans, especially those who have lost their jobs.

Hard Times

The coronavirus pandemic has left millions of people without jobs – and without health insurance. Those who are in need of prescriptions for chronic conditions or serious medical issues still need their medications, and so many are getting their prescription drugs from other countries, where they can be half the price of what they cost in the US. It is illegal for Americans to import prescription drugs into the US for personal use, but for many, it is a matter of life and death.

“With the economic and health consequences of COVID-19 disproportionately impacting minority and low-income populations, more people in those groups may be seeking an alternative way to meet their medication needs,” said Young-Rock Hong, an assistant professor of health services research, management and policy at the UF College of Public Health and Health Professions.

Safety Concerns

illustration of persons hand with a coin and risk assessment next to it with the arrow pointing at orange — *Buying medication from other countries can pose safety risks to those taking them.*

Buying medication from other countries can pose safety risks to those taking them. Roughly 1 in 10 medications sold in the world are substandard or fake, according to the World Health Organization, and taking these drugs can lead to medical issues or even death.

“Patients need to be knowledgeable of these potential dangers they will encounter, and insurance policies that search to pursue drug importation ought to reinforce high quality assurance and strict monitoring processes to advertise protected administration of imported remedy within the U.S. market,” Hong mentioned.

It is best to purchase medication from a trusted source to reduce the risk of any possible consequences of taking a fake drug, or a drug with a lower dose than labeled. If that is not possible, especially for the millions of Americans who have lost their job and health insurance, there are other solutions to get an affordable health insurance plan. EZ can help find a great affordable plan within budget so that medication does not have to be sought out from abroad. An EZ agent will compare plans and find the right plan for anyone’s needs. Our service comes at no cost, because we simply want to help people find a great insurance plan, and get the medications that they need. To find an affordable plan and medications, enter your zip code and a bar above or to speak to one of our agents call 888-350-1890.