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Seniors using Medicare Part D are overpaying for prescriptions, study says

By Nicholas Gerbis
Published: Monday, December 11, 2023 - 9:05am
Updated: Monday, December 11, 2023 - 9:56am
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Medicare is meant to keep healthcare affordable for seniors.

But a new JAMA study of 50 generic drugs suggests Part D participants are overpaying for drugs because private insurers are artificially inflating costs.

Three-quarters of Medicare recipients are enrolled in Part D plans, which cover prescriptions through private insurers.

These insurers reimburse pharmacies for the drugs they dispense; if insurers overpay, they can “claw back” some of that money.

But, in the meantime, patient copays are based on the original, higher drug value.

In one case, insurers reimbursed $126 per tablet for a cancer drug that cost pharmacies $4.20. That’s a difference of more than $3,600 for a 30-day supply.

The U.S. Senate has already targeted the general problem for reform, but the JAMA study is the first to establish its specific impact on Part D.

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