I looked up Part D drug plans for Arizona on Medicare.gov to find out how many stars they get. For 2012, there will be 30 Part D plans available in Arizona, and most of them get 2.5 or 3 stars, which is average. The star ratings go from 1 to 5, five being the best.

Only one Part D plan in Arizona gets 4 stars. This plan costs $47.20 per month and has a $320 deductible.  I don’t know if this 4-star plan is worth $47.20 per month when you can get a 3-star plan with the same deductible for $15.80.

The $320 deductible means you pay the first $320 of your drug costs, and then the plan kicks in.

To compare plans, I put two drugs into the Medicare.gov Plan Finder:  Crestor and Proventil HFA.   The $15.80 plan covers Crestor for 20% of the retail cost of the drug after the deductible is met. So, once the $320 deductible is paid (after two months), the cost of Crestor would be $27.20.  This plan doesn’t cover Proventil (which costs $57).

Most of the plans do not cover the Proventil inhaler. Most cover Crestor for a $45 co-pay (plans with a deductible and plans without). Only a couple of plans cover Proventil for a $27 co-pay.

The 4-star plan didn’t have any information on what its co-pays are, or what the drugs I entered would cost, so I can’t say if it’s worth $47.20 per month.

My conclusion is that 4 stars vs 3 stars is not a big deal. The key is:  Which plan covers your drugs at the lowest overall cost for the year?  The Medicare.gov Plan Finder will give you that info, but you need to figure out where to find it.

And I will say once again….”Why are there so many Part D plans? Why does it have to be so complicated? Is it saving Medicare money?”

Insurance companies manage Part D plans and negotiate prices with drug companies, but Medicare pays the bills – to the tune of $78 billion in 2010!!

Part D really bugs me because it is so complicated – and plans change each year. One of my clients called me to say her $25 plan premium is going to $71 for 2012.  I have left messages for two other clients who are enrolled in that plan, which seemed like a good deal two years ago.

Medicare handed Part D over to insurance companies and made it ridiculously complicated.  Why? Why? Why?

PS:  I know why.

The Medicare.gov Plan Finder has 2012 information available, and there will be 30 stand-alone Part D plans sold in Arizona next year.

From a quick review of 2012 Part D plans, it looks like the two most popular stand-alone plans increased their monthly premiums by less than one dollar. (I can’t mention the names of plans because I am an insurance agent and somebody might say I’m promoting them.)

I had a call from a client who said her Part D premium is going from $25 to $70. At first I thought she was probably confused by the materials she received from her Part D plan.  But I discovered that her premium is, indeed, going up that much!  This Unicare Part D plan was one of the lowest cost plans without a deductible.  I don’t know why anyone would stay in this plan – and I have a few clients in this plan I need to call!

If a plan has a large premium increase, or drops coverage of some drugs, thousands of seniors who don’t pay attention will get a very big shock in January when they get their Part D bill or go to fill a prescription. But in January they will be locked into that Part D plan for all of 2012 – and Medicare won’t make an exception for them just because they didn’t read their mail.

Everyone enrolled in a Part D or Medicare Advantage needs to read the mail they have recently received from their plan, called the “Annual Notice of Change” (ANOC). The ANOC provides information on any changes that are being made to their plan for 2012.

Part D Changes to look for: 

Did the premium increase substantially?

Are all your drugs still covered by the plan – and will the co-pay be around the same price as for 2011? Sometimes plans will move a drug from tier 2 (with a co-pay of $45) to tier 3 (with a co-pay of $80).

Medicare beneficiaries have until December 7th to put in an enrollment form for a new Part D plan that would start on January 1.  Insurance agents can talk about plan details as of today, October 1, but they can’t take an enrollment form until October 15th.  The Medicare Open Enrollment Period is now October 15th to December 7th.

Seniors on Medicare who are diabetic face high co-pays for their insulin prescriptions, even when they have a Part D plan. Most types of insulin are tier 2 drugs with a $40 or higher co-pay for each vial.  Some of the newer drugs for diabetes are even tier 3 drugs, which mean they can cost $70- $90 per month in co-pays. For seniors living on Social Security payments, spending hundreds of dollars each month for their drug co-pays can cause financial hardship.

A recent article in the New York Times that says that older drugs for treating diabetes have been found to more effective in controlling blood sugar than new and more expensive drugs.

The May 27 NY Times article said:

The researchers concluded that drugs that have been around for years are more effective at lowering blood sugar and often work with fewer side effects than the newest drugs. And because so many older drugs now are available as generics, they often cost just a fraction of the price of newer brand-name drugs.

Low-cost treatment is imperative to turning back the diabetes epidemic, said Dr. Wendy L. Bennett, assistant professor of medicine at Johns Hopkins University School of Medicine and the lead author of the A.H.R.Q. study. Experts estimate that only 25 percent of diabetic patients are getting the treatment they need, and expense is a big reason. Even well-insured patients may reel when confronted with the $6,000 a year it takes on average to manage the disease (not counting the costs of such complications as heart disease, stroke, and liver and kidney damage).

The NY Times article offered advice for people who are newly-diagnosed with Diabetes:

Metformin almost always works as a first-line drug, except for patients suffering from severe kidney disease, said Dr. Bennett. What’s more, Metformin generally does not cause hypoglycemia, a common and dangerous side affect of many diabetes drugs.

Choose combination drugs from among inexpensive generics,  [such as] Glimepiride, $13 for 100 pills (1 milligram) or Glipizide, $64 for 100 pills (5 milligrams).

Most diabetics will have to eventually take more than one drug to keep blood sugar under control. The good news here from the Johns Hopkins study is that inexpensive metformin is also quite effective in combination with other generics, such as glimepiride and glipizide.

Do not start with one of the more expensive drugs in combination with metformin. In some cases, patients ultimately may need a combination of both generics and the newer drugs, but this usually becomes appropriate only after a less expensive combination has been used for some time or if the patient isn’t responding to the less expensive combination.