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How will the Inflation Reduction Act affect Medicare enrollees?
Under the new law, Medicare beneficiaries will see a series of prescription drug-pricing provisions phased in – mostly over the next several years
Nearly three-quarters of readers feel overwhelmed by Part D options
We asked how confident our readers were with comparison shopping for a Medicare Part D plan during the 2022 Medicare Annual Enrollment Period. Here's what we learned from more than 350 survey responses.
Majority of survey participants don’t review their Medicare Part D coverage options annually
in our latest survey, we asked how often our readers review their Part D coverage options. The good news? More than a third of respondents review their options annually.
Medicare Part D – prescription drug coverage
Medicare Part D subsidizes the costs of prescription drugs for Medicare beneficiaries. Enrollees select Part D coverage by enrolling in either a prescription drug plan (PDP) or a Medicare Advantage plan (MAPD).
Which Medicare Part D prescription drug plan should I choose?
Factors to consider when choosing your part D coverage include the total cost (premium plus out-of-pocket costs) and whether you prefer Original Medicare or Medicare Advantage.
Four signs you need to change your Medicare Part D coverage
Reasons to consider a change to your Medicare prescription drug coverage may include high premiums, changes to your prescriptions or your plan's formulary, and your access to in-network pharmacies.
8 ways to cut your prescription drug costs
But prescription drugs – and drug coverage – can be less expensive if you're willing to do a little research and to reach out for help. Here are eight strategies that will empower you to take control of your drug coverage and your medication costs.
Over 75% of seniors take prescription drugs, and one-third of people over 65 take an average of six prescription drugs. With statistics like these, it’s no surprise that prescription costs are among the top concerns for Medicare beneficiaries.
Even with Medicare Part D or private insurance to help cover the costs of prescriptions, there are still co-pays, coinsurance, and coverage gaps which can leave beneficiaries paying out-of-pocket. These expenses can create a financial drain and stretch fixed incomes to the breaking point – and even drive beneficiaries to risky behaviors that include rationing – or foregoing – their prescriptions.
But prescription drugs – and drug coverage – can be less expensive if you’re willing to do a little research and to reach out for help. Here are eight strategies that will empower you to take control of your drug coverage and your medication costs.
The first step toward curbing your drug costs begins at enrollment. When you’re choosing a Medicare Part D plan (either a stand-alone plan or Part D coverage that’s integrated with a Medicare Advantage plan), look closely at the specifics of how the drug coverage works. Pay attention to co-pays, deductibles, and coinsurance amounts, and be sure to use Medicare’s plan finder tool to see how each plan will cover any medications that you’re already taking.
A recent analysis of prices on the top 10 most commonly prescribed brand-name medications determined that some Medicare Part D plans had prices up to 14 times higher than other comparable plans. To start comparing Medicare Part D plans, you can visit Medicare.gov.
Many prescriptions are long-term, and taking them can become part of your daily routine. It can be easy to one day find yourself with a regimen of pills – including some you may not need to take anymore, or that may now have a less expensive alternative. By taking an inventory of your prescriptions and talking to the person who prescribes them for you, you can eliminate redundancy, cut prescriptions entirely, or find better or equivalent lower-cost alternatives and generics.
While speaking with your prescriber, also inquire if you can get a prescription for a 90-day supply. Not only will this eliminate the need for monthly refills, it can also slash the costs for many drugs. The 90-day savings can stretch even further when coupled with a mail-order prescription service (which is more convenient and less expensive than a trip to the pharmacy each month).
Just as we can become complacent in our daily medication regimen, we can also fall into patterns with our pharmacy of choice. The location, staff, or store loyalty may keep you coming back, but that loyalty can be straining your pocketbook.
The prices for prescriptions can vary drastically from pharmacy to pharmacy – even if one pharmacy is physically located right down the street from another. Amateur sleuth time: call or visit new pharmacies to price check your medications. This is important to keep in mind when you’re comparing Part D drug plans (step 1, above): You’ll want to check to see how the various plans cover your medications at a range of different pharmacies in your area. You might find that even with the same plan, your costs are lower if you switch to a different pharmacy.
To find greater savings, you may need to leave the chain stores, and consider a pharmacy in a grocery store, or located in a big-box retailer. But also take a look at small independent pharmacies, which negotiate different deals with drug manufacturers and distributors and can offer significant savings from their bigger competitors.
Sometimes, the best way to save money on your prescriptions, is to NOT use your insurance. An online prescription discount site (such as GoodRx) will offer a simple online search of your drug and show you multiple prices and options in your area along with coupons or codes to get discounts.
Discount prescription cards are also available from retail outlets, and provide similar savings. Even better, many prescription cards now offer delivery services, which often include even deeper discounts.
Finally, it’s worth noting that if you use a discount Rx program instead of your Medicare coverage, your out-of-pocket costs won’t be counting towards your Part D TROOP (true out of pocket) or OOPM (if you have an employer-sponsored plan). Depending on what your pharmacy needs end up being throughout the year, that could be an important point to keep in mind.
Most pharmaceutical manufacturers offer discounted or free prescription drugs for qualified individuals. Not every company will offer discounts on every drug, but when available, these programs be an effective way to fill your prescription needs, particularly for high-priced and specialty prescriptions. Reach out to a company directly, or search the database at Medicare.gov to determine drug availability and where to go for savings.
As an example, the popular rheumatoid arthritis drug Humira – manufactured by AbbVie Biopharmaceuticals – can retail for $7,000 for a month’s supply. By accessing the company’s income-based assistance program, some consumers can get Humira prescriptions filled for as little as $5 a month – or even free.
Another resource in the battle against prescription drug costs is pharmaceutical assistance programs in each state. For a list of state-based assistance programs, you can contact your state’s Insurance Department or Department of Health and Human Services, Elderly and Adult Services Division.
State-based assistance programs do vary widely. Some require an enrollment fee, set income requirements, or allow application only during coverage gaps. Others cover medicines for certain conditions only.
State Health Insurance Assistance Programs also provide free counseling to explain Medicare prescription coverage options available in your state.
Extra Help is a federal government program for Medicare beneficiaries who have prescription drug coverage, but who need help covering the prescription costs, co-pays, deductibles, premiums and coinsurance for Medicare prescription drug plans.
To determine whether you’re eligible, Social Security will require you to submit an application that will help the agency assess the value of your savings, assets, income, and other sources of wealth (apart from your primary residence). If you qualify for Extra Help and aren’t currently in a Medicare prescription plan, you may even qualify for money back on prescription expenses you accrued while waiting to be approved.
America is a nation of givers, and home to nonprofits dedicated to practically every cause, including medications for individuals in need. Begin with an online search for a particular condition, and chances are, you’ll find great resources that can reduce your prescription costs. The National Council on Aging offers a tool that searches for benefits programs based on your geographic area.
Prescription drugs can improve the quality of your life – and even save your life. Devoting a little time to research can help ensure you won’t be priced out of the medications you need.
Jesse Migneault is a journalist and editor who has written about business, government and healthcare – including public and private-payer health insurance. His articles have appeared in HealthPayerIntelligence, the Hartford Courant, Portsmouth Herald, Seacoastonline.com, Foster’s Daily Democrat, and York County Coast Star.
In addition, his work has been cited by health industry stakeholders such as the Eugene S. Farley Health Policy Center, Association of Healthcare Journalists, American Academy of Actuaries, Kaiser Permanente, blueEHR, San Diego Law Review, Medicare Agent News, healthjournalism.org, and Concierge Medicine among others.