Let’s say your doctor prescribes Repatha to lower your cholesterol. Repatha is a newer drug that works different than statins. According to goodrx.com the price for Repatha at the local pharmacy is between $1200 and $1300. In what might seem like a miracle of good fortune, Amgen, the maker of Reptha, offers a “copay card” that, for eligible patients, reduces the copay to no more than $5 per month.
The problem is that it’s only available for those with private insurance. Patients with Medicare Part D prescription drug coverage simply aren’t eligible. Why?
The reason is that it’s illegal under a federal anti-kickback law to allow drug manufacturers to offer this kind of a discount. The rationale behind the law is that makers of brand-name pharmaceuticals offering coupons might dissuade patients from considering lower-cost alternatives. Lower cost, that is, to the U.S. government.
Certainly many have cried foul, claiming the policy is unfair. With 44 million people, or around 15% of the U.S. population, enrolled in Medicare, it’s a policy that affects a large group. Further, Americans aged 65 and older fill more than double the number of prescriptions per year than those aged 18-64 (Source: Georgetown University) and income is also often reduced and fixed for this group. So, arguably, it also affects a subset of the population that is in most need of, or at least may most appreciate, cost savings in this area.
There are some things that those on Medicare can do, though. Check out our article “How to save money on prescription drugs when you are on Medicare“.