Health insurance companies are facing a dilemma: they have to offer lower deductibles and copays on some products because the average cost of drugs has been climbing and consumers are more willing to pay.
But as the costs of the drugs rise, the discounts they offer to consumers is shrinking, according to a new study from the University of Michigan.
The study, which analyzed data from more than 50 million people in the United States and Canada, found that a typical Medicare beneficiary was paying an average of $3,600 for a first-line drug and $4,400 for second-line drugs, but the discount was actually decreasing as drug prices climbed.
The average price of a new first-generation antibiotic, for example, is about $2,000 more than the average price in 2015, but consumers are less willing to shell out for a second-generation drug, according the study.
That could have significant consequences for Medicare’s overall spending and Medicare Advantage, the Medicare Advantage plans that help seniors purchase private health insurance, according a letter from Medicare CEO Marilyn Tavenner to members of Congress.
The federal government has already cut its first-year discount in half, from $1.10 to $1 to $3 per pill, and the price of most drugs is expected to continue to climb.
But the new study indicates that some Medicare Advantage drug plans will still offer discounts to the general public for some drugs, as long as they are covered by Medicare.
That’s the big news.
The big change, however, is that the average prices for first- and second-stage drugs are actually declining over time, said Dr. Matthew M. Brown, a physician at the University at Buffalo Medical Center who wasn’t involved in the study and who co-authored a separate analysis of Medicare Advantage drugs.
The Medicare Advantage program covers the vast majority of drugs in the US.
But there are some drugs that are especially expensive.
For example, one new type of antibiotic, called metronidazole, costs more than $1 million for first treatment, but less than $600 for second treatment, according Medicare’s drug plan.
Some people don’t think about these costs when they decide how much they want to spend on their health care, Brown said.
If you have a doctor who tells you the cost of a medication is $100,000, that’s a huge shock.
But a new report from the Congressional Budget Office found that seniors who pay their doctors a higher price for their health services could save $4 billion over the next decade if they just paid less.
If a person in a Medicare Advantage plan can afford the $1 per pill for first and second stage drugs, that can save them $5,000 in a single year, according Brown.
The savings would be even greater if they don’t have to worry about paying the deductible for those drugs, Brown noted.
The findings are part of the ongoing debate over whether Medicare should increase its cost-sharing program, or whether it should phase out its cost sharing entirely.
A few states have already dropped their cost-shifting incentives, including New York and Illinois.
A second study from Tufts University found that people in Medicare Advantage programs who were not enrolled in Medicare Part D, or the federal health insurance program for the working poor, actually lost money on average, but that the losses were more pronounced for those who were enrolled in the program.
The Tufts study, released Wednesday, used data from the Centers for Medicare and Medicaid Services’ Survey of Prescription Drug Plans to estimate the impact of changing the cost-share for drugs that were used for chronic conditions.
The analysis found that the most significant impact on the bottom line was the loss of more than 10 percent of the average annual savings, as compared with a typical enrollee.
For some people, the loss was even greater.
For people in Medicaid and CHIP, for instance, the average loss was 18 percent of their annual savings.
“We know that if you have low-income enrollees who can’t afford the cost sharing, then there’s a real incentive for providers to reduce their cost sharing,” said Robert C. Woodson, a Tufts professor who coauthored the Tufts report and a former member of Congress from Georgia who is now a fellow at the Urban Institute.
The new study is a first step toward the possible introduction of a single-payer health insurance system in the U.S. The Congressional Budget Center has already estimated that the Affordable Care Act would cut the deficit by $8.8 trillion over the coming decade if all of the country’s Medicare recipients were enrolled.