Many people with Medicare find that they are paying a hefty amount for their drugs, even with prescription drug coverage. Drug companies have considerable power to set high prices for many drugs; insurers have little power to rein them in. Instead, insurers shift costs onto members who need high-cost drugs. That helps explain why government drug price negotiation remains a top policy issue in polls of likely voters. For now, there are ways to keep your drug costs down.
Whether you are enrolled in a Medicare Part D prescription drug plan or a Medicare HMO or other private Medicare plan, copays or coinsurance for some drugs can be extremely high. Here are some options to save you money.
- Review the drugs you are taking with your doctor: Your primary care doctor might be able to shorten the list of drugs you’re taking and, in the process, save you money. If you’re taking high-cost brand-name drugs, your primary care doctor might also be able to prescribe you lower-cost generic drugs. Generics must have the same active ingredients, same strength and purity and same effect.
- Ask your Part D drug plan or private Medicare plan about reducing your copay: If your drug is in the highest tier—requiring a very high copay–the plan might reduce the copay if your doctor can demonstrate that you have no other drug alternative for your condition that safely meets your needs.
- Extra Help: If you qualify for Extra Help, a program administered by Medicaid, it will pay for some or all of the cost of your drug coverage. The amount of help with cost-sharing depends on the level of your income and assets. In 2023, you may qualify if you have up to $20,385 in yearly income ($27,465 for a married couple) and up to $16,660 in assets ($33,240 for a married couple). With Extra Help your drug costs are no more than $4.15 for each generic/$10.35 for each brand-name covered drug. You pay nothing after your total drug costs exceed $7,400. And, depending upon your income, you may pay only part of your Medicare drug plan premiums and deductibles. You get Extra Help automatically if you have Medicaid or a Medicare Savings Program. You can apply for Extra Help online here.
- Find out if you qualify for a State Pharmaceutical Assistance Program: In some states, state pharmaceutical assistance programs provide help with the cost of drugs. Visit Medicare.gov or contact your State Health Insurance Program to find out about drug benefits your state provides. You can also call 1-800-677-1116 or visit www.eldercare.gov.
- Drug company assistance programs: Some drug companies offer eligible individuals reduced prices for their drugs. Contact the Partnership for Prescription Assistance or NeedyMeds to find out if you qualify for help with your drug costs.
- Online pharmacies: You can often find significantly lower-priced drugs through online pharmacies. And, increasingly, people are using international online pharmacies to keep their costs down. Kaiser Health News reports that 19 million people in the U.S.–eight percent of Americans–now buy their drugs outside the US to afford them. But, you must be careful you are using a legitimate pharmacy and not an outfit selling counterfeit or expired drugs. Also, it is technically illegal to import drugs from abroad, although it appears that no one has been prosecuted for doing so for personal use. Here’s what to consider.
Keep in mind: If you are a Vet, you likely can get low-cost drugs through the Veterans’ Administration.
N.B. This post was originally published on November 18, 2019 and has been updated.
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KILL THE “DONUT HOLE”. When non generics are non existent, it’s discriminatory, cruel and inhumane considering epidemic ailments such as diabetes, heart and stroke, etc.
You are absolutely correct. Inhumane and predatory are the basic tenets of American greedy healthcare system. Big Pharma leads the way. Americans have been brainwashed for so long,they came to accept it as status quo.
What are the pharmaceutical investments of Tennessee state representatives and senators and our congressman and senators and Washington?
I was told by my pharmacy that if Medicare-D paid even a few cents on a medication, no drug company assistance program would apply. Medicare effectively prevents you from taking any advantage of drug company offers. Talk about catch-22.
1. Done that, got a new prescription for yet another pill
2. Per my doctor this is just a way to get you off the phone, he has tried this and it never works
3. My income is too high
4. Not in Texas
5. Doesn’t work if you are one Medicare
6. I’m not a vet
Remember when George W Bush lied to everyone when Medicare Part D was passed, he said that we would never have to worry about drug prices again because big pharma would always be fair on pricing. Interestingly, that’s when drug pricing explode and the pockets of the average person’s pockets got picked legally
The six tips don’t include a very important step all Part D enrollees should take every year: use the Medicare website’s Plan Finder to determine whether one’s current plan is the best choice for the coming year. A high proportion of those who do this learn that they could save, often substantially, by switching to a different Part D plan. But most people don’t use the Plan Finder annually, so they are often spending significantly more than they would if they identified and switched to a plan that is cheaper for their particular list of drugs. Anyone who needs help with a Plan Finder can get it from a nearby SHIP site, senior center, or AAA. The deadline is December 7.
Most countries’ national health systems negotiate drug prices with pharmaceutical companies but part of the Medicare Part D law proscribed Medicare from doing this. What was the purpose of this proscription?
In 2020 My part D deductible is $435. The insurance company has stopped covering my drugs because they are too expensive. Forced to take the most expensive generics that even the FDA admits don’t work, with no help from insurance. Unable to function or work now without the brand name drugs. Now what?
One additional tip on saving on Part D drugs. My plan charged $75 for 90 day supply of a generic I take. COSTCO mail order charged me $13 which savings paid for $60 annual membership. For the rest of the year I will save $180 and my insurer will forgo that Il gotten revenue. I see it as a win win for me. I saved money and i cost the insurer money.
Biggest scam in American history- your healthcare!