Deena Flinchum
There hasn’t been much in the way of new developments in Medicare of late. The 2018 tax bill produced a few changes, mostly positive.
First, this law closes the donut hole for brand name drugs a year early in 2019 instead of 2020.
This means that the coinsurance for Part D prescriptions will be 25 percent in 2019 rather than 30 percent on brand name drugs. Additionally, it increases the discount provided by the manufacturers to 70 percent from 50 percent.
As near as I can tell from available information, beneficiaries will pay 37 percent of the cost of generic drugs in the donut hole in 2019 and just 25 percent in 2020.
Second, biosimilar drugs will be treated just as other brand name drugs in the donut hole.
Currently they are not included in the donut hole discount program. According to a Fortune article in 2015, biosimilar drugs “are less costly imitations of drugs known as biologics, which are used to treat a range of diseases including cancer, rheumatoid arthritis, diabetes, and anemia. But they are different from generics in that they are not exact copies.”
Biosimilar drugs are not common in the US yet. They are expected to lower the costs for treating conditions such as those noted above but are not expected to lower costs as much as true generic drugs now do.
Basaglar, a biosimilar insulin, is already being used in some European countries under the name of Abrasia. The availability of such drugs could be very good news for diabetics because the price of insulin has soared in recent years.
Finally, the new law will raise the cost of premiums for Medicare Part B and Part D for beneficiaries who have incomes of over $500,000 for singles or $750,000 for a couple. I doubt that very many of us here in the New River Valley will be facing this increase.
There are a number of changes proposed in the President’s FY2019 budget, but until Congress actually begins to consider this budget, it is impossible to tell where any particular proposal could end up and in what form.
There is one issue that remains in the FY2019 budget that should be of considerable interest to Medicare beneficiaries. This issue is the possible defunding of the SHIP program that enables us to assist Medicare beneficiaries in navigating the intricacies of Part D drug plans during Open Enrollment and the entire scope of being new to Medicare.
It has been my experience that our legislators aren’t hostile to this program—they just can’t seem to remember what it does.
If you can, please remind them that VICAP, our local SHIP program, saved Medicare beneficiaries in the New River Valley over $600,000 last year.
This information should get their attention.
