Medicare is going broke or so we have heard for years. One must ask why? Are there too many people on Medicare? Is the cost of services too much for the system to handle? Is the Part B premium enough? Many questions with no real answers. We are going to look at one aspect of Medicare regarding the cost of services to provide some answers. Let me explain as I am a senior and it is my situation we are going to examine.
A close friend of mine has Rheumatoid Arthritis and has had it for almost 30 years. Prior to going onto Medicare, he was given Enbrel for 10 years. Two shots a week at home and was fine. The medication cost $1800 per month but he got the drug for $10 per month through the manufacturers discount program. When he went onto Medicare, he was told by the Embrel manufacturer that they could not give me Embrel any longer for $10 but if he wanted it he would have to pay the $1800 per month against his drug plan and the cost was astronomical. That seemed unreasonable. That situation may have changed as of this blog but also may sit exist.
He talked it over with his Rheumatologist and due to the financial situation with Embrel decided to go on an infusion once per month in the doctor’s office. That infusion costs $4000 per month and Medicare paid about $3400. Between Medicare and his supplement, the entire cost was covered and all he paid was his monthly Medicare and supplement premium. Seems like a very workable situation. But was it?
My answer is no and the costs that Medicare must bear times the hundreds of thousand people with Rheumatoid Arthritis is one of the reasons Medicare is going broke. Now consider other diseases, too numerous to mention here and you get the picture why Medicare is going broke. What I am saying is the treatment costs are excessive; and the alternatives have never been considered is the problem. One alternative is to have the pharmaceutical manufacturer continue providing the drug at $10 per month while on Medicare. The fact that they allow the $10 copayment monthly for those under Medicare age and not allow it once on Medicare makes no sense. At the time I got a letter through my Congressman from CMS (Medicare’s governing body) allowing me to get the drug for $10 while on Medicare. The drug company would no cooperate and did not accept the letter from CMS. One must wonder why?
Reviewing the situation would indicate that this is a workable solution for Medicare. The only issue was that the drug part of Medicare would have required going in the donut hole but a ruling from Medicare could have fixed that so the $10 copay would be considered the total cost of the medication with an exemption for the balance. This could be done for many expensive medications under Medicare. My question is why this is not being considered as an alternative for Medicare and how many other situations exist like this that are not being addressed? I personally am happy with the situation because the disease is being treated and I am fine with the results. Financially I am fine and would be with the $10 per month alternative as well.
I am writing this so many seniors can see the results of bad decisions by Medicare which had been going on for many years. Like all things in government, the best or least expensive alternatives are not being considered. It is time for Medicare to make some changes so everyone will have Medicare for years to come. The President has made an executive order reducing the cost of diabetic medication to $35 per month instead of the current costs. Is this a step in the right direction? It’s too soon to tell but it looks like it is headed in the right direction.
The Barend Agency Inc