SHERIDAN — Health and Human Services Secretary Kathleen Sebelius announced last week that Medicare recipients in Wyoming have saved about $9.5 million on prescription drugs since the passage of Affordable Care Act in 2010.
According to a media release from agency, savings were accumulated mostly by the closure of a gap in coverage commonly refereed to as the “donut hole.”
“By making prescription drugs more affordable, the Affordable Care Act is improving and promoting the best care for people with Medicare,” Sebelius said in the release.
Department officials claim the ACA makes Medicare prescription drug coverage — also known as Part D — more affordable by gradually closing a gap in coverage where beneficiaries must pay the full cost of their medications out of pocket.
People with Medicare in the donut hole now receive discounts when they purchase prescription drugs at a pharmacy or order them through the mail, until they reach what’s called the catastrophic coverage phase. The ACA gave those who reached the donut hole in 2010 a one-time $250 check, then began phasing in discounts and coverage for brand-name and generic prescription drugs beginning in 2011. The law is expected to provide additional savings each year until the coverage gap is closed in 2020.
Nationally since the law was enacted, more than 6.3 million people with Medicare have saved over $6.1 billion on prescriptions, according to Health and Human Services.
Still, some local pharmacists said that while some patients are likely saving money, their business has become more difficult to conduct thanks to regulatory changes to the industry.
“What we’ve noticed is more formulary changes,” said Meyer, owner of Hospital Pharmacy and Hospital Pharmacy West. “They’re pushing everybody toward these multi-source generics.”
Meyer said that among the few people who do reach the donut hole gap in coverage, most don’t hit that point until sometime later in the year. As a result, he can’t say with much certainty whether his customers have seen substantial savings in 2013.
“I don’t know that I’ve seen too many people who are saying they’ve seen less cost,” he said.
Meyer added that while restructuring of certain insurance processes can lead to a perceived lower cost for the consumer, those changes can often mean a drop in levels of service.
“When you reduce margins at the retail level, you’ve generally got to reduce service,” he said. “There’s no such thing as a free lunch anymore in this game.”
Lois Bell, staff member at the Sheridan Senior Center, said that based on anecdotal conversations with Sheridan seniors, not many seem to have saved directly by changes to the donut hole.