OPERS pharmacy expert interviewed on NPR
Brian Lehman, OPERS’ nationally recognized expert on pharmacy issues, recently was interviewed by National Public Radio on why we are fighting to see more “biosimilar” drugs approved in the United States. One big reason: They save consumers money.
Biosimilars are generic versions of biologics, specialty drugs used to treat illnesses such as rheumatoid arthritis, Crohn’s disease, multiple sclerosis and a variety of cancers.
Lehman, a pharmacist and OPERS’ pharmacy benefits and policy manager, estimates that half of OPERS’ prescription costs will come from specialty biologic drugs by 2018. While these drugs currently account for just 2 percent of the drugs that our retirees use, they contribute one-third of our total drug cost.
Working to improve access to specialty drugs helps us keep costs low for OPERS retirees, and we want to make sure seniors on a limited income can have access to affordable drugs. Over 10 years, OPERS could save $134 million if 11 biosimilar products come to the marketplace.
Lehman was featured in an OPERS video last year, discussing prescription drug coverage under the Connector. You also can find it on our YouTube channel.
Michael Pramik
Michael Pramik is communication strategist for the Ohio Public Employees Retirement System and editor of the PERSpective blog. As an experienced business journalist, he clarifies complex pension policies and helps members make smart choices to secure their retirement.
I retired in 2000. My wife is on a biologic (Humira) for rheumatoid arthritis. BEFORE Medicare we paid a total of $60 (sixty) dollars a YEAR out of pocket for this drug due to discounts we were able to receive from the Manufacturer. AFTER Medicare, we are paying just over $6000 (six thousand) dollars a year out of pocket for the same drug because Medicare won’t allow us to accept any discounts from any drug company. In most respects, and for most people, Medicare has been a life saver . . . without it most of us would never be able to afford the treatment we need to maintain our health. For anyone on a biologic, Medicare’s prescription policies are going to bankrupt us. Something needs to change very soon. Thank you OPERS for recognizing and acknowledging our dilemma and pushing for reforms. Please keep up the fight on our behalf.
Thank you for your thoughts Tom.
-Ohio PERS
what about the drug cost of insulin for diabetics. Mr Pramick you were more concerned about the Cadillac tax than about the retires cost
William,
The cost of insulin and diabetic supplies are indeed rising. We recognize that fact, and we continue to promote more-affordable drugs including insulin, biosimilars and biosimilars generic to insulin.
What we do know is that manufacturers are working on biosimilar or “follow-on” insulins as we speak. The biggest one is Basaglar, which is a “follow-on” biologic drug for Lantus and is expected to be in the market by Dec. 15.
Other tips we are providing include using generic supplies when possible, talking to your doctor and pharmacist for access to manufacturer coupons, and comparing the cost of brand products with http://www.goodrx.com. Also, as open enrollment approaches, consider selecting a different plan through the Connector.
–Ohio PERS
Michael, If you are on medicare , you do not qualify for discount coupons to help with the costs and you need to meet an income criteria.
Marion,
You’re correct, but it may be possible to not use your Medicare coverage when you have your prescription filled. If the coupon would be cheaper than the coverage, why not opt for that? Ask your pharmacist if that’s possible.
–Ohio PERS
Marion,
The drug companies seem to be quite vigilant in their acceptance of coupons. Thank you for that valuable information.
–Ohio PERS
I used a GoodRx coupon just today to fill a prescription. I am on the Humana/Walmart Medicare Part D plan and the prescription was shown as a tier 3 (or 4) drug, so I would first have had to apply the cost toward my deductible (all out of pocket), then pay a copay. I checked with a Walgreens Pharmacy, and found that they can fill that prescription WITHOUT processing it through my Medicare plan . . and so I could then use the GoodRx coupon, which reduced my cost by about 66% . . a significant savings over using my Medicare Part D coverage.
Tom,
Thanks for that feedback. We’re glad that worked out for you.
–Ohio PERS
Thank you for reaching out.
I want to clarify that OPERS did not drop health care for retirees. We made changes to preserve health care for retirees long into the future. Without these changes the health care program would not have been able to be sustained. To do this, OPERS wanted to find more affordable options for retirees, and the Connector was able to offer this. In addition, OPERS provides retirees an allowance which is intended to further help with qualifying expenses.
CVS owns SilverScript; if you have been receiving medication through mail order, they may have identified themselves as CVS when they called which is where some of the confusion may have come in. If you are not already using goodrx.com, you may want to explore this website for manufacturer coupons which may assist with lowering your cost. Another option may be to talk with your treating physician to explore other options (generic forms). Please keep these costs in mind as you plan ahead for next year and this fall’s open enrollment as you may find a different RX plan that better suits your needs.
– Ohio PERS
Thanks for the update….I will work on making some changes….I am thankful to have the coverage I have but I sure do miss OPERS! Thanks
Please Heather Drago, don’t make promises OPERS may not be able to pay way “into the future”. Seems not long ago we heard the same old, same old.
Marion,
We are working with our Pharmacy Benefit Manager and will reach out to you shortly.
Thank you for sharing,
-Ohio PERS
on the donut hole I was told what you pay plus the fifty percent drug discount counted toward the 1540.00 amount. To let everybody know that the Drug store can not tell you how much counts in the donut hole.
who do you call.
William,
If you have questions about the donut hole, here’s the number for Medicare: 800-MEDICARE. There’s also a lot of information on the Medicare website about the donut hole.
–Ohio PERS
After reading these comments I am scared to death. My husband turns 65 in October, we will be attending a seminar next week. What is the donut hole as it relates to medications? Does this apply also to drugs administered either in the hospital or chemo drugs? We are already losing money each month with contributing more and more to my spouse health care which eventually won’t be provided at all. Now I am reading of this pharmacy drug issue — OPERS should not penalize their retirees at age 65 by providing less benefits than pre-65 — how on earth did this happen???
These are great questions. Medicare is a great resource for learning more about the donut hole. Their phone number is 800-MEDICARE. There’s also a good deal of information on the Medicare website https://www.medicare.gov/part-d/costs/coverage-gap/part-d-coverage-gap.html.
–Ohio PERS