A Kaiser Family Foundation analysis finds that prices for commonly used brand name drugs are rising in 2010, with increases since 2006 far exceeding the growth in inflation.
The Medicare Part D benefits coverage gap generally requires enrollees to pay the full cost of drugs after their total drug spending exceeds their initial coverage limit until they reach the threshold for receiving catastrophic coverage.
Under current law, the coverage gap under the Part D – or "doughnut hole" – standard benefit is $3,610 in 2010, and is projected to increase to $5,755 by 2018. In 2007, an estimated 3.4 million Part D enrollees reached the coverage gap.
Using data posted on the Medicare Web site, the Kaiser analysis looks at prices for commonly used brand-name drugs without a generic substitute for enrollees in stand-alone prescription drug plans. The prices reflect the amount that enrollees would pay for a 30-day supply after they reach the coverage gap and before catastrophic coverage begins.
For example:
- The price of Actonel, a treatment for osteoporosis, increased 8 percent, from $91 in 2009 to $98 per month in 2010. Since 2006, its price has risen 39 percent.
- The cost of Aricept, a treatment for Alzheimer's disease, increased 7 percent between 2009 and 2010, from $184 to $198 per month. Since 2006, its price has increased 41 percent.
- The price for Plavix, for preventing blood clots, rose from $142 in 2009 to $152 in 2010, a 7 percent increase. Since 2006, its price has gone up 25 percent.
Beneficiaries in Part D plans who reach the coverage gap pay significant out-of-pocket costs before qualifying for catastrophic coverage – assuming they continue to take their medications.
The Kaiser analysis was authored by a team of researchers at Georgetown University, NORC and the Kaiser Family Foundation.