OK not a dumb Medicare rule, but a dumb federal rule. But isn't Medicare a federal program? In any event before he went on Medicare my DH could get Humira for $5 a month by using the manufacture's discount card. Now that DH is on Medicare he can no longer use the card and Humira will cost him $8000 year. It is an awful dumb rule.
Yes, Medicare is a federal program. And it isn't a "rule" that we are talking about. It is a statute passed by Congress. Rules and statutes aren't the same thing. Like many statutes, this one actually has a purpose. It is to stop Kickbacks. You don't want companies giving kickbacks in order to entice the federal government to do business with the company.
Let's say there is a medicine where the cost for it would be $3000 for it. The patient is not in the donut hole yet and so Medicare pays most of it. The patient however can get a prescription card from the manufacturer and pay $200 for the medicine. Now, on the surface this is good for the patient and for Medicare. Yay!
Now, let's imagine there is a competitor medicine which costs, say, $1500. And, let's imagine that this medicine is better than the $3000 medicine. It is more effective with less side effects. If the choice is between $3000 and $1500 it is a win/win for the patient and Medicare for the $1500 medicine to be used. It is less money and better.
But, the second medicine has no prescription card. But the patient knows the first medication has a prescription card and Medicare knows it too. So the patient and Medicare want the first medicine because it is so much less expensive (with the card). But, the patient is now getting a less effective medicine.
The purpose of the statute is theoretically (among other things) to stop this. The idea is to not have the choice distorted by the prescription card. If the manufacturer can get along with the amount from the discounted prescription card then maybe the manufacturer should just charge less for the medicine.
The point is that the statute does have a legitimate reason for the rule. In an ideal world though he solution is not to have Medicare recipients get prescription cards. Prescription cards can distort drug pricing. For example, I was recently prescribed something (I only had to take it once) that was almost $200 without a card. I would have paid it all since I hadn't met my Part D deductible. With the card it was $35. So, people who don't have Medicare get the medication for $35. The manufacturer knows that Medicare recipients can't get the medication for $35. So the manufacturer can give the $35 cards for non-Medicare recipients knowing Medicare recipients would pay far more. Without the cards, perhaps the cost would be spread out more evenly among others. Also, even people eligible for prescription cards don't always have them because no one tells them about the cards. That is also a problem.
The real solution to the problem here is not so much to let Medicare recipients use prescription cards. It is for Medicare to be able to negotiate drug prices like regular insurers can do.
