These 10 strategies for reducing drug costs is for those who are frustrated by the cost of prescription medications in the US? Is it because you have no control over the retail prices charged for the medications you require? You’re in the majority, however there are methods and strategies that will help to minimize your out-of-pocket expense. This article will discuss several proven strategies that have helped many of my Medicare clients substantially reduce their cost of medications and avoid falling into the dreaded Medicare “Donut Hole.” True, these strategies work for Medicare beneficiaries, nevertheless eight out of ten of these strategies can be used by anyone at any age.
Strategies for use by anyone at any age to reduce their cost of prescription medications:
1. Switch a brand-name for a generic drug:
Your doctors and pharmacists can give you information on which brand-name drugs are available as generics. This can amount to substantial savings each year for all who use it and may keep Medicare beneficiaries you out of the “Donut Hole.” In our example above, if the $425 brand-named drug could be switched with a generic costing $50, instead of entering the Donut-Hole after month 10, our total drug cost would be less $500. Always check with your prescribing doctor before switching prescription medications.
2. Samples:
These strategies for reducing drug costs should be used at every appointment and with every doctor, ask for samples of any drugs you have been prescribed. Many drug manufacturers provide doctors with a limited quantity of various drugs to promote their product. The doctor decides how much of the drug to give and to which patients, while supplies last. These samples are often for brand-named drugs and can create a substantial savings.
3. In-store prescription programs:
Walmart, Costco, Sam’s Club, and many grocery stores have low-cost generic drug program and many include brand-named drugs at retail price. Often the retail price of a drug is lower than the insurance copay. Purchase what you can from these programs for cash out-of-your-pocket, as they only require a prescription from your doctor, and they do not report to your insurance plan. If you are on Medicare, do not purchase your cash out-of-pocket generic drugs from the same pharmacy where you use your Medicare Part D Plan for your brand-name and expensive generic drugs.
4. Preferred pharmacies:
Most Prescription Drug Plans (PDPs) Plans have preferred pharmacies, where you’ll get a lower price for using their services. Also, check out the mail order program offered by your plan as it’s often the least expensive option.
5. In-pharmacy coupons:
For the more expensive drugs, your pharmacist will often have a coupon program that will give you a lower price than your insurance copay. I have one prescription that is not covered by my Medicare insurance and would cost $152. every three months. However, my pharmasist supplies a cupon and I receive this prescription for $22.
6. Prescription Assistance Programs:
These programs have helped millions of people with their expensive drugs. Many are strictly web-based. The nonprofit site, NeedyMeds.org, can be reached by telephone at (800) 503-6897.
7. Blink Health:
Blink Health has negotiated low prices on over 15,000 medications, and they pass the savings on to the public. Whether you are insured, uninsured, or under-insured, all you need is a prescription from your doctor. You pay online and print a card which works like an insurance card with no copays. Present the Blink Health card and your doctor’s prescription to the pharmacy at the time of pickup. Blink has a network of pharmacies you must use, and they do not cover all drugs. Drugs purchased through Blink Health do not count toward your Stage 2 Initial Coverage Limit. Blink can be telephoned at 1 (855) 979-8290 or reached online at www.blinkhealth.com.
8. Singlecare:
SingleCare ranks on our 10 strategies for reducing drug costs and is a prescription savings card that works with over 35,000 pharmacies nationwide to save you up to 80% on over 50,000 prescription medications. They provide online and phone app services which allow you to type in your medication name and it will list the prices at the least expensive pharmacies in your area. Sign up is free and there will never be a cost to you. A card will be issued to you to present at the pharmacy along with your prescription. You may also download an app that will enable you to search on your phone. Yes, you must have your prescription sent to the pharmacy of choice. Log on to https://www.singlecare.com/ or download the app on your phone to use the program. SingleCare can be reached toll free by telephone at: 1-844-234-3057.
For Medicare Beneficiaries: How to Save Money and Avoid or Postpone the Donut Hole.
The term Donut Hole is a metaphoric reference to the Coverage Gap Stage in the convoluted yearly progression of drug costs for those on Medicare. The four stages of this yearly cycle are Stage 1 Yearly Deductible, Stage 2 Initial Coverage, Stage 3 Coverage Gap (Donut Hole), and Stage 4 Catastrophic Coverage. Once the total retail cost of prescription medications reaches $4,200 for 2020, the beneficiary moves from the Stage 2 Initial Coverage into the Stage 3 Coverage Gap. The beneficiary remains in the Coverage Gap until reaching a personal yearly out-of-pocket cost of $6,350 for 2020. Then they move into the Stage 4 Catastrophic coverage where costs significantly drop for the rest of the year.
Understanding what costs are applied during the different stages of the yearly Medicare cycle of drug coverage is paramount in lowering out-of-pocket costs. Medicare Drug Plans mask the true cost of medications behind the facade of copays.
The chief reason Medicare recipients dread entering the Donut Hole is reflective of the change in their cost of drugs during this stage. Once in the Donut Hole, standard copays are no longer relative and we become responsible for 25% of the retail cost of our drugs whether they are generic or brand named.
For those concerned with the possibility of entering the Donut Hole, it is important to remember that the retail cost of the drugs you are prescribed, and not just the copay amount you are charged, determine your plunge into the Donut Hole. We often compare the copays of different Medicare Advantage or PDP Plans when determining which Plan best suits our needs for the following year. However, the retail price of the drugs is the important issue when it comes to the Donut Hole.
Example: after satisfying any applicable yearly deductibles in Stage 1, you will move into Stage 2 where you will be charged a copay ranging from $0 to 33% of the retail cost of the drug. You may walk away from the pharmacy delighted that you only paid a $45 copay for your brand-named drug and not realize that the retail cost of $425 is the amount applied toward calculating your move from Stage 2 Initial Coverage into the Stage 3 Coverage Gap or Donut Hole. This one drug can land you in the Donut Hole after the 10th month of the year. The Donut Hole for 2020 begins at $4,200 and 10 (months) X $425 (retail price) = $4,250. This means the beneficiary will be in the Donut Hole for November and December and the drug will cost 25% X $435 = $106.25 per month. Medicare drug stages reset yearly on January 1.
9. The Plan Finder tool:
This handy tool can be found on the Medicare website at www.medicare.gov/find-a-Plan/questions/home.aspx. Whether it is your first Advantage or PDP Plan, or you are merely comparing plans during the AEP, this tool will help you find accurate information on the cost of drugs and determine which plan and pharmacy are the most cost-effective for you. After filling in some confidential personal information, it will direct you to an important page of resources. Here you will find information on prescription drug assistance programs, pharmaceutical company discounts, community-based programs, and nonprofit and retail drug discount cards available in your area.
10. Use of Two Pharmacies: No Donut Hole for Me!
A major strategy I teach my clients is to use two pharmacies. While it may seem a bit inconvenient, this strategy can be extremely cost effective. Many pharmacies, including those located in grocery stores, offer a list of generic drugs for a low cash price, usually $4 or $5 per prescription. The key here is that it is a cash price tendered without the use of insurance and the cost will not be added in the calculations toward the Donut Hole. A drug that cost you $4 may have a retail price of up $50 or more. If you are taking one brand-named and three generic drugs, this can put you in the Donut Hole if you purchase all your drugs at the same pharmacy with your insurance coverage. However, if you purchase the generics for a cash price from one pharmacy and the brand-named at another pharmacy using your insurance you may stay well away from the Donut Hole.
If you fail to use two separate pharmacies, when your cash purchase arrives in the pharmacies accounting department, it will be matched up with your insurance coverage so the pharmacy can acquire any reimbursement available. This will add the retail drug cost to the total used in calculating when you will move into the donut hole and nullify this strategy.
If I can assist you in any way, especially with Medicare related questions, please feel free to contact me through my secure portal at https://ronelledge.com or at ron@ronelledge.com.