What imbalance exists in prescription drug spending, and how has it impacted overall costs?
Answered by 10 licensed agents
A recent report highlighted a stark imbalance where generic drugs, despite being 91.5% of prescriptions, only represent 12.9% of the drug spending, while brand-name drugs, at 8.5%, account for 87.1% of costs. This disparity contributed to an 11.4% increase in drug spending, reaching $450 billion, primarily due to rising costs for treatments of diabetes and obesity.
Answered by Brian Moore on February 16, 2025
Broker Licensed in OH
The only imbalance that occurs with a Medicare Advantage is IF their medications are not on that carrier's formulary. Otherwise many of the members medications will be covered and typically are $0 costs for a Tier 1 & Tier 2 medication
Answered by Melonie Wood on March 27, 2025
Agent Licensed in FL & AL
In 2025, Medicare eliminated the Part D Coverage Gap (a.k.a. Donut Hole). This now limits the consumer from spending over $2000 on all covered prescription drugs. However, not all plans may cover all of your medications, so ensure you verify Part D plan options in your zip code at www.Medicare.Gov.
Answered by Christopher Boyd on March 4, 2025
Agent Licensed in IN, KY, MI, OH, PA & TN
Pricey name brand drugs take up way more money than cheap generics. Special meds, like for cancer, make it worse. This affects everyone, with folks often paying more than insurance does. This drives up drug costs big time, and lots of people can’t afford their meds, which can lead to bigger health issues down the road.
Answered by Bryan Smith on March 10, 2025
Broker Licensed in UT, AL, AR & 35 other states
The deductibles and the co-pays have gotten a little bit out of hand because of the change with the coverage gap going away. It’s actually costing people more money in the long run.
Answered by Karen Boudreaux on March 13, 2025
Agent Licensed in TX, AZ, CA & 5 other states
In 2025 there is an imbalance exists in prescription drug spending, because it uses to be four cost stages on a drug plan now it is only three cost stages. The deductible, initial coverage and catastrophic which comes when over 2000 has been spent on drug by client and plan. This means the client pay 0 dollars for rest of year which should be less than previous years.
Answered by Ben Washington on March 25, 2025
Broker Licensed in IL, FL, MN, SC, TX & WI
The biggest imbalance, in my opinion, is Pharmacy Benefit Managers (PBMs). Most consumers aren’t even aware they exist. PBMs are the middleman between drug manufacturers and pharmacies. They negotiate all the pricing for the drug plans. They are a thorn in the side of many local pharmacies. Essentially, they are the ones who never seem to sacrifice, while the local pharmacies suffer.
Another recent issue that went into effect in 2025, is that the government has shifted the majority of the drug cost burden from themselves to the insurance companies, forcing them to cut other benefits in their plans and pass costs on to the consumer.
Answered by John Stagner on March 25, 2025
Broker Licensed in MO & TX
The biggest imbalance that I see is the overall cost of medications. Whether that cost is passed out to the consumer or the health insurance company. Lower medication costs mean both the consumer at the health insurance company keep money in their pockets. It’s obvious why this is important to the consumer. For the health insurance company it means that money could be spent on other benefits and keeping plan copays low.
Prescription drug costs are too high. Max out of pocket yearly will help a great deal though. Going from over $5000 to $2000 max
Answered by Martin Cahill on March 4, 2025
Agent Licensed in MA, CT, FL & 5 other states
The costs of prescription drugs rises faster than inflation in many circumstances, causing an imbalance and financial pressure.
Answered by Aisha Saleem on March 13, 2025
Agent Licensed in MD & FL
Tags:
Medicare Part D
Prescription Drug
Agents: Share Your Expertise
Have insights or experiences related to this topic? Help others by sharing your knowledge and answering this question.
Add Your Answer
