7 Tips to Save on RX Costs

Prior to joining Medicare most people don’t realize the very high costs of prescriptions.

​Most pre-65 and Group Insurance plans (other than High-Deductible HSA type plans) have simple copays for drugs … e.g. $10/$40/$60… or $7 generics 50% brand name up to $125 max. 

How to avoid or delay the donut hole!

After joining Medicare, this all changes since the Initial Coverage level with Part D is capped ($3,700 retail cost in 2017).  

​For example, if you happen to be a diabetic taking the following common medications, you would hit the donut hole in month 3 or 4.

• Januvia (~$385/month retail cost)
• Humalog (~$500/month retail cost)
• Lantus (~$375/month retail cost) 

Prior to the donut hole you may have a reasonable copay e.g. $30-$50 for each of these three medications, but then when you reach the donut hole and have to pay 40% the cost of these medications (until you reach catastrophic coverage). After 12 months on Part D, you are likely to spend $2,000-$3,000+ just on these three drugs! 

This is just one example of many high cost RX examples we see for people on Medicare.   

Below is a list of 7 tricks to help save on your RX costs.  

Each of these tricks could save you hundreds or even thousands of dollars per year on your RX costs! 

1. “Load up” on your Medications before going on Medicare – Group Health Plans and individual pre-65 insurance plans don’t have a “Donut Hole” like Part D of Medicare.  In most cases, the individual just pays a co-pay for their medications.  If you are approaching your Medicare start date, in most cases, I recommend you ‘load up’ on your medications using your existing coverage before joining Medicare so you delay or eliminate the Part D donut hole impact. Depending on the medication and the plan you have, you could “load up” on 3 months or even 6 months of the medication on your current plan before joining Medicare.
2. Use Generics, when possible – I am Not a Doctor, therefore I obviously cannot prescribe your medication.  However, I know Part D of Medicare becomes much more expensive when you take Brand Name drugs rather than Generics, if Generics are available.  So talk to your doctor… if there is a lower cost generic drug that will be just as effective, it will save you lots of money on your Medicare Part D costs.  There also could be lower cost brand name drugs, if a generic is not available… talk to your doctor. 
3. Review your Part D Analysis each year – You have one opportunity every year (Oct 15 – Dec 7) to review and change your Part D plan.  I highly recommend that you take advantage of this opportunity.  Part D of Medicare changes every year, Part D Prescription Drug Plans change every year, and your RX list could change every year.  We provide all of our clients with a free review of the Part D plan each year and ~ 25% of the time the best Part D plan for the following year is not the same plan the individual has in the current year. 
4. Use the Preferred Pharmacy or Mail Order – Depending on your Part D Plan and your specific list of medications, you could save several hundred dollars per year or even over a thousand dollars per year, using the best method to fulfill your medications.  For example, there are a couple of low-priced Part D Plans (Humana Walmart and AARP Walgreens), which have preferred Pharmacies.  Both of these plans (and the other 20+ Part D Plans) may have lower prices if you use mail order, but it really depends on the specific drugs and Part D Plan you select.  In some cases, Mail Order actually ends up costing a lot more than just going to the pharmacy. These are just a few examples. Each Part D Plan generally has different pricing at different pharmacies or mail order.  This is why we recommend that you take advantage of the tools on Medicare.gov to complete the Part D analysis based on your specific list of drugs.
5. Check if you qualify for a state assistance program – there are some great state assistance programs that could save you thousands of dollars per year.  For example, in NJ the state-assistance program is called PAAD (Prescription Assistance for the Aged and Disabled).  If you qualify, the state pays your Part D Premiums and your copays are only $5 for generics and $7 for brand name drugs. A PAAD beneficiary must have annual income for 2022 of less than $38,769 if single or less than $45,270 if married.  The nice thing about qualifying is they don’t check Assets… it’s purely based on income!  Find our more about PAAD here.  If you are not in NJ, you can do a simple Google search for "Medicare RX Assistance insert Your state here" and you should get some great information about signing up for a State Assistance program.
6. Check if the medication is covered by Part B of Medicare – some VERY expensive medications are covered by Part B of Medicare.  If you have a decent Medicare Supplement (e.g. Plan F, G, N, H, I, J), this is great news since Medicare Part B will pay 80% and the supplement will pick-up the 20% of the drug cost not covered by Medicare.   If you are taking any injectable / infusion treatments administered by the doctor, you should definitely inquire to see if they are covered by Part B of Medicare.  Also, there are some expensive chemotherapy pills that can be covered by Part B as well.  Check with your doctor.   Another good savings example with Part B drugs is if you are diabetic and the doctor indicates an insulin pump is medically necessary, both the supplies and the insulin in the pump should be covered by Part B.  This could save someone thousands of dollars per year on their insulin/supplies costs!
7. Inquire about Pharmaceutical assistance – Medicare.gov has a great tool where you can search for assistance directly from the Pharmaceutical company based on a specific drug name.  The tool provides the eligibility criteria, how to apply, how the benefits work, etc.  If you are taking an expensive medication, this is another great tool to try and save some money on your RX costs!

 
Bottom line, you should work with an expert to make sure you are optimizing your RX dollars each year.  

Call now 908-272-1970 if you need help signing up for Part D, or you can fill out our FREE RX Analysis Form each year during the Annual Enrollment Period (Oct 15 – Dec 7).