Still more on Medicate Part D

Having now signed both my mother and my mother-in-law up for prescription drug coverage under Medicare Part D, I learn there's still another complication I hadn't even contemplated. It appears that when you walk into the pharmacy with your drug coverage card, the amount the pharmacy will charge you for the drug depends upon the plan you're signed up under. So, one plan may charge you $500 for a drug you would have paid $50 for if you weren't covered at all. Then, your plan might make you pay a 25% co-pay. In the end, you pay $125 for a drug you could otherwise have purchased for $50 if you weren't insured. Here's the scoop.

Let's consider how this system will work in practice, using the drug Actonel, a once-a-week pill routinely prescribed for elderly patients to combat osteoporosis, as an example.

Of the 48 commercial Medicare drug plans offered in Southern California, three don't cover Actonel at all; their enrollees will have to pay full price. Twenty-eight plans require prior authorization. The remaining 17 plans cover the drug, no questions asked.

That's not all. There's wide variation in how much each plan charges for a month's supply. Most price it around $500, or $125 per pill. One lists a month's supply at $470. Blue Shield lists it at $602....[But] any patient can purchase a month's supply of Actonel from drugstore.com, an online pharmacy, for $67.99, cash — spending slightly more for a year's supply than some plans charge for a month.