Affordability and Coverage of Prescription Drugs for Seniors: A Gallup Poll and a KFF Study

by Clive Riddle, November 15, 2019

West Health and Gallup have just released results from a new survey on healthcare costs that found 13.4% of U.S. adults had “a friend or family member [who] passed away after not receiving treatment for their condition due to their inability to pay for it.” That percentage decreases with age: 16.9% under age 45, 12.4% between age 45 and 64 and 6.6% age 65%+  knew someone passing away.

That might seem counter-intuitive, given the greater frailty of seniors, but greater income levels compared to those under age 45, combined with stable coverage (Medicare) factor in. By income the percentages were 18.5% under $40k annually, 11.1% between $40k to $100k, and 9.1% over $100k.

Prescription drugs pricing was a particular focus in the survey, and “89% of U.S. adults report that drug prices are either ‘much higher’ or ‘somewhat higher’ than what consumers should be paying for them.” The survey found “28% of women vs. 18% of men have been unable to pay for prescription drugs;’ and that “medication insecurity skyrockets to 42% among those with annual household incomes of under $40,000.”

Today’s seniors have something the previous generation did not –the availability of  Medicare prescription drug coverage to help insulate from drug costs, and Kaiser Family Foundation has just released a new study: Medicare Part D: A First Look at Prescription Drug Plans in 2020.

Here’s eight things to know from KFF’s study:

1. The average Medicare beneficiary will have a choice of 28 PDPs in 2020, a 29% increase from 2017
2. A total of 948 PDPs will be offered in 2020, an increase of 202 PDPs since 2017.
3. Among the 20 PDPs available nationwide, average premiums will range sixfold from a low of $13 per month for Humana Walmart Value Rx Plan to a high of $83 per month for Express Scripts Medicare Choice.
4. Two-thirds of Part D enrollees without low-income subsidies will have premium increases in 2020 if they stay in their same plan, and one-third will have premium decreases.
5. The estimated national average monthly PDP premium for 2020 is projected to increase by 7% to $42.05
6. In 2020, all PDPs will have a benefit design with five or six tiers for covered generic, brand-name, and specialty drugs, and cost sharing other than the standard 25% coinsurance, similar to 2019.
7. 86% of PDPs will charge a deductible, with most PDPs charging the standard deductible of $435 in 2020.
8. Among all PDPs, median cost sharing is $0 for preferred generics and just $3 for generics, but $42 for preferred brands and 38% coinsurance for non-preferred drugs plus 25% for specialty drugs