Prescription drugs | Agility Insurance Services

When it comes to prescription drug costs, there can be significant differences between employer-sponsored health plans and Medicare. Understanding the differences between the two can help your clients save money and ensure you help them get the coverage they need. Here’s what your customers need to know about employer-sponsored health plans and Medicare.

Cost:

Generally speaking, employer-sponsored plans tend to pay more for drugs than Medicare. This is because employers often negotiate discounts with drug manufacturers, allowing them to offer lower drug costs than Medicare.

Coverage:

Employer-sponsored health plans may provide more comprehensive coverage for prescription drugs than Medicare. Some employer-sponsored plans may cover drugs not covered by Medicare.

Out-of-pocket costs:

While employer-sponsored health plans may pay more for drugs than Medicare, they may also require higher out-of-pocket costs. Employer-sponsored plans may have higher co-pays, coinsurance, and deductibles than Medicare.

Formularies:

Employer-sponsored health plans and Medicare may have different formularies, which are lists of drugs that are covered and excluded. Make sure customers check the formularies for both types of plans before making a decision.

Specialty drugs:

Many employer-sponsored plans have higher copays and coinsurance for specialty drugs. Medicare, on the other hand, has lower copays and coinsurance for specialty drugs.

Prior authorization:

Employer-sponsored plans may require prior authorization for certain drugs, while Medicare generally does not.

Step therapy:

Employer-sponsored health plans may require step therapy for certain drugs, while Medicare does not.

Employer-sponsored health plans and Medicare can have significant differences as far as prescription drug costs. Understanding the differences can help customers make an informed decision about which plan is best for them. Make sure to emphasize to clients that they should compare the cost, coverage, and out-of-pocket expenses for each plan before making a decision.

Your next step as an agent is to learn how Medicare Advantage Plans (MAPD) and Prescription Drug Plans (Part D) play a role in helping your clients control their prescription drug costs. Work with Agility to learn more!

Are you contracted to sell Medicare plans yet? Contact us to get started today!

Agility Producer Support
(866) 590-9771
support@enrollinsurance.com

Inflation Reduction Act Passed

On August 12, 2022 the Inflation Reduction Act (IRA) was passed by the U.S. The House of Representatives and President Biden are expected to sign off on the bill. Already being passed by the Senate, the $740 billion budget reconciliation package includes Medicare drug pricing policies, Affordable Care Act (ACA) subsidies, climate, energy, and taxes.

Allowing Medicare to Negotiate Drug Prices

The IRA enforces the Department of Health and Human Services(HHS) to establish a negotiation program in hopes to make expensive drugs, single sourced, and biological products more affordable. In this program, the HHS Secretary will produce a list of selected drugs that meet certain criteria, and negotiate maximum fair prices on these drugs with suppliers, then renegotiate as needed. The drugs up for negotiation are the top 50 drugs from both Part B and top 50 from Part D with the highest total cost from the latest 12 month period. However, the negotiations for the Part D drugs are limited to 2026 and 2027, these prices must take effect for 10 of the negotiated drugs in 2026 and then increase to 20 in 2029. For 2026 the expenditure period to be reviewed is June 1, 2022 through May 31, 2023, and the selected drugs’ publication date is September 1, 2023. Studies show that seniors aged 65 or older require at least four prescription medications, and 1 out of 4 say that it is difficult to afford all of their prescription drugs. In particular, low-income seniors are more severely impacted, and this act being passed will provide savings of hundreds or thousands of dollars annually.

Addresses Climate Change

The Inflation Reduction Act provides $369 billion to help minimize greenhouse gas emissions that are mostly responsible for climate change and related health complications. This is the most spent to combat the effects of climate change in United States history.

What are the benefits from the passage of this bill?

As of now, 14.5 million people in the United States use a state or federal health insurance marketplace for their insurance needs. The policy will aid millions of lower or middle-class individuals or families to purchase affordable insurance. Since these credits took effect, African-American and Latin communities’ enrollment has seen a significant increase in willingness to enroll in health insurance versus other years.

The IRA is one of the largest spending bills in the history of the U.S. There are many more details than are covered in this article. For more information, please click here!