5 Ways Seniors Can Save on Prescription Drug Costs
By Joe Globensky, RFC®
Healthcare costs continue to rise, particularly for those on prescription medication. As the debate drags on (and on, and on) in Washington D.C. over how to lower drug prices, we must rely on ourselves to save money. And for seniors on Medicare, who may be living on a fixed income, here are five ways to save money on prescriptions today.
Comparison Shop Prescription Drug Plans Every Year
The Medicare Annual Enrollment Period (AEP), sometimes called Open Enrollment, runs every year from October 15 – December 7. This is a great opportunity to shop the available prescription drug plans (PDPs) to ensure you are in the most cost-effective plan, for your drugs.
There is no good or bad PDP. It’s how each handles, and pays for, the prescriptions you are taking. We have seen many examples where seniors can save upwards of $1,000 or more just by switching to a plan that covers their prescriptions more economically. They may not have to change to a different drug, or change pharmacies, or even rely on mail order. It’s just a simple change to a plan that provides better coverage for their drugs.
Unfortunately, this was made a little more difficult this year. The Center for Medicare and Medicaid (CMS) “upgraded” their plan finder tool. I’ve been using it for three weeks now. Let me tell you, it’s no upgrade. While they are working diligently to make improvements in a timely fashion, the initial rollout caught everyone by surprise. This may be a great time for you to seek out an independent insurance agent that can help you with your search. The PDP premium is the same whether you do-it-yourself or you use an agent.
Use Mail Order (When It Makes Sense)
Most of the Medicare PDPs offer a list of preferred retail pharmacies, but also have a mail order option. Some of the benefits of mail order include avoiding the line at the local pharmacy, getting a 90-day supply of your prescriptions, and possibly having lower costs compared to the retail pharmacy.
But it’s important to know the difference in your drug co-pays at both the preferred retail and mail order pharmacies. While mail order may save you money on one prescription, it may not save you money on all of them. It could even cost more! Each PDP has a schedule of co-pays based on the type of pharmacy you use. Most also have websites where you can find the type of pharmacy that will provide you with the lowest co-pay.
Ask About Generics
Sometimes brand drugs are prescribed even though a perfectly adequate generic drug is available. It is important to ask your doctor if there is a generic, and if the generic will work in the same manner as the brand drug. If so, the doctor can write the prescription so that a generic can be substituted. This way, the pharmacy can determine based on your PDP, which drug will cost you less money.
I had a client call me recently after hip surgery and she was prescribed two brand drugs and one generic. She was calling me from the hospital to ask about the cost of these drugs on her drug plan. One brand drug was over $1,300 for a one-month supply and the other was over $700 for a 10-day supply. Each had a generic equivalent with a cost 90% lower than the brand drug. I suggested she speak with her doctors to see if the generics would work as well in her case. It was determined that they would, thereby saving her almost $1,800. It never hurts to ask.
Make Good Use of Your PDP Formulary
Each PDP has a drug formulary list that is created by the insurance company. Each formulary is required to have at least 1 – 2 drugs in each drug classification or category. And then those drugs are assigned to 1 of 5 tiers. A Tier 1 preferred generic drug on one PDP could be a Tier 2 non-preferred generic drug on another PDP.
You don’t need to have the tiers memorized. But knowing they exist could help you save on prescriptions in the future. Outside of the AEP, unless you are entitled to a Special Enrollment Period, you won’t be able to change your PDP. If you are prescribed a medication that is a Tier 3 or 4 drug on your plan, you may have options. You can find the drug in your formulary, and you will also find the other drugs in the same category, and the tiers to which they are assigned. This might help you to determine if there are Tier 1 or 2 drugs in your formulary that you can ask your doctor if they will work just as well as the one prescribed. And these typically come with a lower co-pay.
Leverage Your Doctor and Pharmacy
Let me share two of my own experiences on how helpful a doctor’s office can be in helping you save money. Several years ago, my eye doctor prescribed some eyedrops. She gave me a discount coupon in case it was expensive with my insurance. When I went to get the prescription filled, the pharmacy told me it was $200. I provided them the discount coupon from my doctor. It cost me $15.
In a more recent incident, I was told a prescription was not covered by my insurance, so the cost was going to be over $800. I did a little research and discovered there were other formats the drug could be dispensed. I called my doctor’s office. Instead of prescribing a different format, they transmitted the prescription to a different pharmacy. The pharmacy called me to confirm my information, mailed me the prescription, and it cost me $0. That is not a misprint. Sometimes we might have to work to save on prescriptions. But, with little effort, I was able to save myself over $1,000 on two medications. You bet I would do it again.
I specialize in helping clients with their Medicare planning, including researching and selecting prescription drug plans that can save them money. If you would like to compare your current plan to others that are available, please call me at (217) 605-8130, e-mail me, or use our online scheduler to setup a 30 minute phone call. It doesn’t cost you anything, and it may even end up saving you money.
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