How to Lower your Part D Prescription Costs
There are many ways you can reduce your prescription drug costs each year through your Medicare Part D Prescription Drug Plan (PDP). The Part D Prescription Drug Plans, which are offered by private insurance companies, have very different deductibles, premiums, consumer cost sharing amounts, lists of covered drugs, preferred pharmacy networks and pharmacy tier placements
It’s important to understand the many differences that exist between companies and the potential effect on your out-of-pocket costs.
Many people don’t understand how much premiums alone can vary among Prescriptions Drug Plans for a consumer on identical prescription drugs. According to the Kaiser Family Foundation, a non-profit organization that focuses on health care research and communication, PDP premiums vary widely across plans in 2018. Among the 10 PDPs with the highest enrollment average, premiums will range from $20.21 per month ($243 per year) for Humana’s Walmart RX to $83.68 per month ($1004 per year) for AARP Medicare RX Preferred.
Review Your Plan Each and Every Year
Start by shopping and choosing a Medicare Part D Prescription Plan that matches your individual needs. Then make sure you review your plan and compare it to other plans offered each and every year. Individual insurance companies will and do change their plans each year. If a plan is the best fit for you one year, it doesn’t mean that it will remain the best plan fit the next year. The Medicare Annual Enrollment period from October 15 to December 7 is your annual opportunity to change to a different plan; a plan that provides the same quality coverage for the best price.
Medicare.gov has a great quoting tool called the Medicare Plan Finder that allows consumers to do a plan-by-plan comparison in your state. You will need to provide your zip code, the list of medications you are taking and your pharmacy choices. Be sure to enter several pharmacies in the quoting tool as this can make a difference in the cost (the tool only allows you to search on any two pharmacies at one time). Your quote on Medicare.gov will result in a list of several Part D Prescription Drug plans and will include data to allow for a big picture comparison; the monthly and annual premium, plan deductible and total out-of-pocket costs. When comparing plan costs, don’t just look at premiums, but at cost-sharing expenses as a whole. A plan with a lower premium may end up costing more overall if it’s offset by expensive copayments and deductibles or a high out-of-pocket maximum.
Medicare Part D Prescription Drug Plans (PDP) vary in numerous ways that can have a significant effect on your out-of-pocket costs. We recommend the following ways to reduce your Part D Plan Costs:
Fill Prescriptions at a Network Pharmacy
Part D plans have networks of pharmacies they contract with. If you fill your prescription at a pharmacy that’s not in your plan’s network, you may pay hundreds of dollars or more each year by going outside the plan’s network.
Be Flexible with your Pharmacy
Using preferred network pharmacies can potentially save beneficiaries hundreds of dollars each year on out-of-pocket costs. Understand that Part D plans have both preferred in-network pharmacies and in-network pharmacies. Prescription medication will be the cheapest at the preferred in-network pharmacies. On the Medicare Plan Finder quoting tool on Medicare.gov, when submitting your pharmacy choices, you may have to expand your radius search from the .5 mile default to the 3 mile radius. If you search using multiple pharmacies, your quote will reveal the least expensive pharmacy (the tool only allows you to search on any two pharmacies at one time).
Switch to Preferred Generic Medications when Possible
Part D Prescription Drug Plans categorize Medicare-covered prescription drugs into different tiers, with higher or lower copayments and/or coinsurance depending on the tier the drug falls under. So although a medication may be covered under your plan’s formulary (the list of covered drugs) it may carry a non-preferred tier status as indicated by its drug tier which would result in a higher cost. Keep in mind that the same prescription may have different costs from plan to plan.
For example, generic medications are categorized under the Tier 1 level and generally are priced with much lower co-pays (and some plans charging zero for generics).
Another way to lower out-of-pocket expenses is to change to a less-expensive drug that works as well for your medical conditions. By switching to a different but still effective drug, you could save hundreds of dollars. As a consumer, make sure you are asking your doctor about generics or even older brand-name medications that do the same job medically. Bring your prescription drug list to your annual appointment with your doctor and have a conversation with them about your medications.
Fill Prescriptions in larger Quantities
Costs can decrease dramatically when you are willing to have your medications filled in larger quantities. Getting a different refill amount can be done through your doctor’s office. Pricing for both 90-day scripts at pharmacies as well as mail-order options can be found on the Medicare Plan Finder on Medicare.gov.
Look for Saving Opportunities in your State
Many drug manufacturers offer cost saving opportunities that may help with the cost of your medications. Go directly to the prescription drug website to determine if a program is available and if you qualify for assistance.
Know about the State Pharmaceutical Assistance Program
Some states offer pharmaceutical assistance programs to help defray the costs of prescription medications.
Wisconsin offers SeniorCare, a prescription drug program for seniors meeting certain income requirements. For more information, you can locate your state on the State Pharmaceutical Assistance Page on the Medicare.gov website.
For more information or to contact Bethany Sullivan at Sullivan Health Care Solutions, please call 262-261-8027.