- Teacher who survived Sandy Hook has book deal
- Jury awards Jesse Ventura $1.8M in case vs. ‘American Sniper’ author Chris Kyle
- Government OKs Arab-owned company to operate U.S. cargo port
- Defense lawyer: McDonnell’s wife had ‘crush’ on CEO
- Chinese hackers stole ‘huge quantities’ of sensitive data on Israel’s Iron Dome
- House unveils bill to speed deportations of illegal immigrant children
- Californians protest middle school for hiring white man to teach cultural studies
- Killer’s sentencing overturned because mother couldn’t find seat in courtroom
- Hillary: ‘Dead broke’ comment was ‘inartful,’ but insists it was ‘accurate’
- Fla. mom arrested for allowing 7-year-old son to walk to park alone
Walmart drug plan for seniors may not be best deal
Question of the Day
WASHINGTON (AP) - Consumer alert: A new Medicare drug plan with the lowest upfront cost in the country may not be for everyone, experts say.
Medicare’s open enrollment season just started, and the plan from insurer Humana and retail giant Walmart is getting attention. At $14.80, the monthly premium is the lowest of any national plan, about half the average. And Humana and Walmart are advertising savings of more than $450 a year for the typical Medicare recipient.
But experts say if you can’t get to a Walmart easily and need costly, cutting-edge medications, it could be a disappointment. You could face copayments as high as 50 percent for drugs purchased at local independent drugstores, “non-preferred” pharmacies as far as the plan goes.
“It may well be a good bargain, but people have to do the research,” said Jack Hoadley, a research professor at the Georgetown Health Policy Institute. “It’s not just the premiums. It’s the premiums plus the drugs they take, and then they have to take into account the pharmacy: Is it practical for them to use the Walmart pharmacy?”
Plan members can choose to fill their prescriptions at more than 60,000 pharmacies nationwide, but only about 4,000 _ Walmart, Sam’s Club or Neighborhood Market stores _ are “preferred,” and offer the lowest copayments.
Hoadley, who in an earlier government career helped lay the groundwork for the Medicare drug benefit, said he believes regulators should take a second look at the network. Residents of metro areas, for example, may have to drive miles to find a preferred drugstore. Consumer advocates say that’s unusual.
Representing both companies, Humana spokesman Tom Noland said Medicare officials undertook a “rigorous review” of the plan before approving it and concluded it met or exceeded the government’s consumer protection standards.
“Overall, the HumanaWalmart plan is an innovative solution in a competitive market,” said Noland. “It is one of more than 1,000 Medicare (prescription) options available to eligible participants nationwide.” Seniors can avoid higher copayments and trekking to the pharmacy by using the plan’s mail-order service, he noted.
About 27 million seniors and disabled people are signed up for the Medicare prescription benefit, offered through private insurance companies. There may be more plan-switching than usual this year, because about 3 million recipients will see their current plan discontinued in 2011 under a reorganization. Government officials say all but 300,000 are being seamlessly switched to another plan offered by the same insurer. But many are facing higher premiums that could prompt them to shop around.
At the Medicare Rights Center, seniors are calling the consumer hotline with questions about the Walmart plan.
“They are asking why it is so much cheaper,” said Joe Baker, president of the New York-based advocacy group. “One reason is this limited pharmacy network, and that’s one thing they should think carefully about.”
Seniors and family members using Medicare’s online Plan Finder to see if the HumanaWalmart plan is a good deal need to remember to enter their drugstore as well as their medications, said Hoadley. Otherwise, the Plan Finder will compute costs based on prices at a preferred pharmacy, which could be considerably lower than what consumers would face locally.
“For many people, there are probably plans with higher premiums that are a better deal, because their drug is included, and their pharmacy is included, and they face fewer restrictions,” said Vicki Gottlich, a senior policy analyst with the Center for Medicare Advocacy in Washington.
The loudest complaints are coming from local pharmacists, who see the HumanaWalmart plan as unfair competition. The National Community Pharmacists Association says it violates the “spirit and intent” of Medicare rules.
“It’s kind of like a beginning of a race to the bottom,” said John Coster, a pharmacist turned lobbyist for the group. Medicare “is sending a signal to other plans that severe restrictions on covered drugs and severe restrictions on access to pharmacies are acceptable. And we think that will put us on a slippery slope to a lower-quality pharmacy benefit.”
TWT Video Picks
- Boehner rules out impeachment: 'Scam started by Democrats'
- Federal judge grants 90-day stay in D.C. gun case
- Obama thanks Muslims for 'building the very fabric of our nation'
- Smugglers, rainstorm combine to poke holes in border fence
- GOP Senate candidate: Obama needs to visit Central America
- D.C. seeks to stay judge's order allowing gun owners to carry in public
- Kerry's credibility questioned as fighting in Gaza rages
- Jury awards Jesse Ventura $1.8M in defamation case
- Rush Limbaugh: 'There is no journalism anymore'
- California's Jerry Brown cites God, 'religious call' to embrace illegals
Obama's biggest White House 'fails'
Celebrities turned politicians
Athletes turned actors
20 gadgets that changed the world