I saw a client last week, and she mentioned she takes Lipitor and it is expensive. I told her Lipitor has gone generic and it should be cheaper now. The generic name for Lipitor is Atorvastatin. I called Costco and asked for the retail price for 30 pills, 10 mg dosage. The price: $17.00.
My client’s co-pay with her Part D plan is 20% of the retail cost of the drug after she pays a $320 deductible. Then her cost is $18.14, meaning the retail cost of the drug is $90.72. How is this possible?
I went to the medicare.gov Plan Finder, put in Atorvastatin 10 mg, and looked at how it is covered by the 30 Part D plans that are available in Arizona. And low and behold…..people with Part D are being ripped off!
Medicare.gov lists plans in order from the lowest to highest cost for purchasing a list of prescriptions. I was shocked to see the huge cost difference from plan to plan for Atorvastatin. Because I am an insurance broker, I’m not supposed to name names in my blog, but I think in this case I must. I am certainly not promoting these plans – just providing information from Medicare.gov.
Remember, 30 Atorvastatin 10 mg pills cost $17.00 for a person without insurance.
Here are some of the results from the Medicare.gov Plan Finder:
Blue Medicare Rx: $30.20 monthly premium: co-pay of $8.00. So this drug is treated as a generic on this plan.
First Health Part D: $23.70 monthly premium: co-pay of $29.76. The retail cost is posted as $70.86.
Health Net Orange Option 1: $25 monthly premium with a $320 deductible. $29 co-pay after meeting the deductible. The retail price is listed as $112.43.
United American Preferred: $50 monthly premium with a $110 deductible. $9.00 co-pay after meeting the deductible.
AARP Medicare Preferred Rx: $28.80 premium; co-pay of $43.00. This is the co-pay for a “preferred brand”.
Humana Enhanced: $33 monthly premium; co-pay of $39.00. Retail cost is listed as $89.95.
Humana Walmart-Preferred Rx: $15.10 monthly premium plus a $320 deductible. $17.41 co-pay after meeting the $320 deductible (ordering by mail or purchasing at Walmart). The retail price is listed as $87.07.
MY QUESTIONS ARE:
Why is Atorvastatin treated as a generic on two plans but a brand drug on the others?
How is it that Costco sells Astorvastatin for $17 while insurance companies are paying $70 – $90 or more for the exact same drug? How is this possible?
It’s the law: While insurance companies administer Part D, Medicare actually pays the bills to the tune of more than $60 billion in 2011. When Part D was created in 2003, the law said only insurance companies (and not the government) can negotiate drug prices with pharmaceutical companies. Maybe Costco should be put in charge of negotiating drug prices!! There is something seriously wrong with this picture.
If Medicare is paying the drug bills, is it paying the Costco price or the insurance company prices, which are five times higher than Costco’s price?
Note: To get pricing information, the Medicare.gov Plan Finder requires you to put in a pharmacy, so I chose Frys, which was the first one on their list.
Note: I called Humana and UnitedHealthcare to confirm their prices and co-pays. They treat Atorvastatin as a preferred brand drug.