Prescription drugs can be a significant expense for Medicare beneficiaries. Fortunately, many Medicare prescription drug plans offer cost-saving benefits. Here are a few tips that can help keep more money in your pocket.
Understand Your Plan Formulary
A formulary is a list of drugs covered by a health plan. It’s important to learn about your plan’s formulary so you can:
- Be sure that the drugs you take, or suitable substitutes, are covered.
- Determine how much you will pay for the drugs you take, including premiums, deductibles and copays or coinsurances.
- Talk to your doctor about lower-cost options.
Many Medicare drug plans have tiered formularies. A tiered formulary divides drugs into groups, based primarily on cost. A formulary might have three, four or five tiers. In general, the lowest-tier drugs are the lowest cost. All plans must cover the same drug categories, but each plan determines which specific drugs it will include and how much you will pay.
If your doctor wants you to take a certain drug or a certain brand name drug, then you need to make sure it’s covered under your plan. Sometimes it’s possible to substitute a lower-tier, lower-cost drug for a similar drug in a higher tier. Ask your doctor what your options are.
Switch to Generic Drugs When Possible
In many cases, a generic drug can be a viable low-cost alternative to a higher-priced brand name drug. Some people are reluctant to use generics, but the fact is that drug makers must prove to the Food and Drug Administration (FDA) that a generic drug is the same as its brand name counterpart in safety, strength, quality, the way it works, how it’s taken and the way it should be used. Also, generic drugs use the same active ingredients as brand name drugs.
Plan formularies are required to include both brand name and generic drugs within commonly prescribed drug categories. You may want to explore generic alternatives and the value they may offer.
Use Network Pharmacies
If your Medicare prescription drug plan has a pharmacy network, then you can save money by using it. Network pharmacies have agreed on special pricing with your plan, so they can offer you extra savings and deep discounts.
It’s a good idea to get to know your pharmacist, too. Pharmacists are a great source of information about drugs, drug interactions and generic alternatives.
Take Advantage of Mail-Order Pharmacy Benefits
Many Medicare plans offer a mail-order pharmacy service. Cost, as well as convenience, can make this service well worthwhile. Copays can be very low, and you can often save even more by ordering a 90-day supply of your drugs at one time. Savings and home delivery are hard to beat.
Get Extra Help If You Need It
Extra Help is a Medicare program that helps people with limited income and resources pay Medicare prescription drug costs, including premiums, deductibles and coinsurance. You must be enrolled in a Medicare prescription drug plan or a Medicare Advantage plan with drug coverage to receive Extra Help.
You automatically qualify for Extra Help if:
- You get full coverage from a state Medicaid program.
- You get help from your state Medicaid program paying your Medicare Part B premiums.
- You get Supplemental Security Income (SSI) benefits.
If you think you may qualify for Extra Help, call Social Security at 1‑800‑772‑1213 (TTY 1-800-325-0778) 7 a.m. – 7 p.m. Monday through Friday, or visit SocialSecurity.gov to apply online. You can also apply at your State Medical Assistance office.
For other great tips and resources for prescription drugs, check out this article on how your pharmacist can be a valuable resource.