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Home » What’s Behind Soaring Medicare Prescription Costs?

What’s Behind Soaring Medicare Prescription Costs?

September 22, 2015 by Ellen LaPlante

Most of us can agree that prescription drug price battles show no sign of letting up. Many of us also know that this is resulting in massive drains to the Medicare program. While the advances of modern medicine and technology are improving the lives of the elderly every day, these same advances are also costing.

For example, new drugs to fight heart disease are projected to cost up to $12,000 a year. Further, just ten new drugs could result in more than a $30 billion price tag for Medicare.

Just last week, the FDA approved two new medicines, to be used together for heart disease, will likely cost $1,000 a month once they hit the market. The drugs work to reduce cholesterol. Unfortunately, most older Americans may not be able to afford the costs.

The therapies are impressive – and certainly effective; the costs are hitting not only individuals but the entire health care industry will feel the strain. Remember, this is nothing new – there are many new drugs on the market that aren’t being utilized to their potential simply because of their price tags.

In 2013, several new drugs created for those with Hepatitis C were approved. Once the price tag was revealed, this so called miracle drug that can cure chronic liver disease with just one treatment was instantly out of reach. Each pill costs $1,000. It’s a three month program and the total cost is nearly $85,000.

If all of this isn’t enough, experts say it’s the tip of the iceberg. It’s believed that all new drugs will hit the market with the same inflexible and outrageous pricing. Make no mistake: these are important medicines with impressive success stories for those with cancer, Multiple Sclerosis and even Cystic Fibrosis.

Avalere Health recently released its own report and what it found was that ten drugs designated by the FDA as “breakthrough” therapies could cost state and federal governments $50 billion over the next decade. Medicare will carry the heaviest burden estimated at $31 billion. Private insurance companies are also gearing up to do battle and they don’t want to be on the hook for these expenses. It matters little how life saving a drug is if the patient cannot afford it. Naturally, the drug companies are saying the numbers are exaggerated and insist costs will remain close to where they are today. They also say generic drugs will play a role as well and can drive costs down even further.

To put it in perspective: A recent report by Express Scripts, a pharmacy benefit manager, found that 140,000 Americans had drug bills of more than $100,000 last year, a 63 percent increase from 2013.

While this is unnerving, these truths highlight the importance of planning ahead. Medicaid and Medicare are two programs many elderly rely on. To learn more about what you may qualify for in terms of healthcare coverage, contact our offices today.

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Ellen LaPlante
Ellen LaPlante
Ellen LaPlante is an attorney whose mission is to provide clients with guidance in Estate Planning, Elder Law, and Medicaid Preparation. She is barred in Vermont and New York. Ellen helps clients put together unique estate plans, including assistance with Trusts, Wills, Powers of Attorney, and Advance Directives. She also works with clients on Medicaid Planning and qualifying for Medicaid assistance.
Ellen LaPlante
Latest posts by Ellen LaPlante (see all)
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