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Four Things to Know About Medicare Drug Coverage

No surprise to anyone with a medical condition that drug prices continue to soar even during this past decade of near zero inflation.  If you have a loved one 65 years of age and older, you need to know about coverage of these increasingly pricey drugs.  The four things you should know:

  • According to a recent Senate minority report, the twenty most commonly-prescribed brand name drugs for Medicare recipients have gone up in price ten times more than inflation over the recent five years.
  • The brand names are: Diskus, Crestor, Januvia, Lantus/Lantus Solostar, Lyrica, Nexium, Nitrostat, Novolog, Premarin, Proair HFA, Restasis, Spiriva Handihaler, Symbicort, Synthroid, Tamiflu, Ventolin HFA, Voltaren Gel, Xarelto, Zetia and Zostavax.
  • Half of these medications have a generic equivalent that can be substituted at substantially-reduced prices: Crestor, Januvia, Lantus, Nexium, Nitrostat, Premarin, Symbicort, Tamiflu, Voltaren Gel, and Zetia. (Synthroid has generic competition, but as a Narrow Therapeutic Index (NTI) agent, switches across manufacturers are a bit challenging; Restasis and Lyrica will have a generic competitor yet this year.)
  • A Pharmaceutical Research and Manufacturers of America industry group spokesperson said the report was misleading, because companies “negotiate robustly” with Medicare Part D. Really?

If you are a caregiver to a Medicare-qualified loved one, it may be time to review their medications with their primary care physician.  Physicians have the option of specifying that a generic alternative may be substituted.  Aside from Synthroid, ask them if they would check the box to allow substitution.  Diabetes treatments, for instance, may be bit more nuanced.  Ask them to explain their reasons.  And do your homework ahead of time so that you know the price differentials of brand versus generic.


Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago.  She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.


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