When NBC DFW asked North Texans about the impact of rising costs, Linda Clark, a retired financial‑services professional, shared her experience with a medication that has become a financial burden after she moved to Medicare. Clark said she has always lived within her means and feels financially comfortable, but the shift to Medicare has introduced a steep new expense.
Medication cost spikes for retirees
Clark explained that the drug Otezla, which she previously received at no out‑of‑pocket cost through her employer’s health plan, now carries a price tag of just over $1,500 for a 30‑day supply. “For me, alternatives haven’t worked before, and this is the one medicine that actually resolved it,” she said, noting the difficulty of switching to other treatments.
Amgen’s response and Medicare limitations
Amgen, the maker of Otezla, responded via email, acknowledging the complexities retirees face when transitioning to Medicare. The company noted that its Otezla Co‑Pay Program is limited to patients with commercial or private insurance and is not available to those whose prescriptions are covered, in whole or in part, by Medicare, Medicaid, or other federal or state programs.
Amgen added that patients may explore other support options by contacting Otezla SupportPlus at 1‑844‑4OTEZLA. The spokesperson also pointed out that Medicare Part D includes a $2,100 annual out‑of‑pocket cap for covered prescription drugs. If Otezla is covered under a beneficiary’s Part D plan or receives a formulary exception, total spending should not exceed that cap for the 2026 calendar year.
Medicare negotiation could lower prices
Clark is not currently enrolled in a Part D drug plan but is looking into it. Starting in 2027, Medicare‑negotiated prices will apply to 15 medications, including Otezla. According to a Centers for Medicare & Medicaid Services fact sheet, the negotiated price for a 30‑day supply of Otezla is projected to be $1,650, down from a 2024 list price of $4,722.
Cynthia Cox of the Kaiser Family Foundation (KFF), a nonpartisan health‑policy research organization, said, “What we’ve seen so far is that the price can come down substantially with Medicare negotiating these drug prices. It still is the case that in the U.S., we generally pay more for prescription drugs than people in other countries do for those same drugs, but it becomes much closer of a comparison when Medicare has started negotiating for the drugs that are on the list.”
Potential solutions and community concerns
Clark expressed concern that many patients may face similar challenges. “It made me think, for me, it’s an itch where if it’s someone who has a heart medication or something like that, what do you do in those cases?” she said. She added, “I just feel like there is an opportunity, huge opportunity, but also there’s a possibility for some sort of solution to make this more affordable for everybody.”
Amgen has also informed Clark about the Medicare Prescription Payment Plan, which allows beneficiaries to spread out out‑of‑pocket costs over the year. While the plan does not lower the drug’s price, it can help manage cash flow for retirees on fixed incomes.
What North Texans can do
Residents facing high prescription costs are encouraged to review their Medicare Part D options, explore manufacturer assistance programs where eligible, and contact their drug manufacturers for any available support. Local health‑care providers can also assist patients in navigating formulary exceptions and identifying lower‑cost therapeutic alternatives.
As the 2027 Medicare negotiation rollout approaches, many hope that the federal government’s involvement will bring broader relief to patients like Clark, ensuring that essential medications remain within reach for seniors and families across North Texas.
Original reporting: Dallas TX News (HLL/CB) — read the source article.
