Part D is too complicated

My Part D premium doubled for 2023.

A friend of mine tried to fill a script only to find that even the generic was not covered by his Part D plan. The pharmacy said it would cost $695 – GoodRx immediately lowered the cost to $195. It’s all too confusing.

Just about any prescription drug coverage is better than none, but the design of Medicare Part D is unnecessarily complicated and negotiating the options for the best deal is a crap shoot.

What if you leased a car, then realized the monthly payment would increase as soon as you drove off the lot, costing you hundreds more?

What if the warranty covers much less than what the dealer advertised?

Welcome to Medicare Part D.

It’s a huge problem for patients, many physicians say. Some who fail to checkopens in a new tab or windowtheir next year’s drug prices during the annual re-enrollment period end up shocked in January when the same drugs they’ve been taking for years, and/or their premiums, end up costing hundreds more in the same plan.

For those who do check, there can be surprises when the posted prices on the Medicare Plan Finder turn out to be wrong, or they’re later contradicted by Part D pharmacy representatives.

Drugs that were the least expensive — even some generics — in Tier 1 may jump to the more expensive Tier 2, 3, or 4 the following year. In any given year, a drug can be priced by one plan in Tier 1, but somehow lands in Tier 2, 3, or 4 in other plans.

What beneficiaries pay may go from a flat copayment to coinsurance, which is a percentage — say 17% or 50% — of the insurance plan’s cost the following year. They may not realize these changes until they get to the pharmacy, or the charge shows up on their statement. The drugs can be exempt from the plan’s deductible, or not exempt.

To make matters even more confusing, Medicare’s rules allow Part D plan insurers to change their formularies after the first 60 days of the year, or immediately if a new generic is released or if there are safety concerns, and in certain other situations too, said Casey Schwarz, senior counsel for the Medicare Rights Center.



  1. Mr. Quinn, you should be blogging about this topic in October and November when people can do something about it, not after it is too late. This blog is becoming becoming like America – way too negative. I suggest you add a reminder to your calendar to write about this top in October. Please use your platform to help raise awareness AND timely action to to improve our country.


  2. From watching YouTube videos, it seems highly likely that my wife’s plans may have to be different than my plan because of our different pre-existing conditions. We can do all the research and still end up on the short end if something new happens during the year because our plan might not have the best coverage for something we didn’t know about when we enrolled. Right now through trial and error we have learned the limits of our current insurance. Usually the only surprise is when a doctor drops the insurance company. However this year I did get a shock when a generic drug finally became available without me knowing about it and I almost got hit with the much, much higher copay but luckily I notice something was off on my mail order request online.

    I’ll find out in 4 years if the YouTubers are correct.


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