Your need for medications will likely increase over time, particularly for age-related chronic conditions. Unfortunately, without insurance, the high cost of prescription drugs can quickly derail your retirement plans. But even with insurance, you may face unaffordable out-of-pocket costs for medications.
Most seniors who have opted for Original Medicare to provide their health care coverage will have bought a Part D Prescription Drug plan from a private insurance company. And those who chose Medicare Advantage will typically have that coverage bundled into their policy.
But, even having that coverage, how can you lower prescription drug costs that often come with deductibles, copayments and coinsurances?
Here’s how those costs are defined:
Deductibles, or what you have to spend before your plan starts paying.
Copays, or the fixed fee you pay for each doctor visit, prescription drug or other service.
Coinsurance, or the percentage you pay of the costs after you have reached your deductible.
You can start by asking your pharmacist these five crucial questions.
Can I save money by paying cash instead of using my insurance?
For years, the agreements between insurance companies, pharmacies and their middlemen (known as pharmacy benefit managers) kept pharmacists from telling you if you were paying too much for your medications. This happened with generics and brand-name drugs alike.
Most consumers don’t realize that health insurance will not always give you the most affordable prices for medicines. And in the past, pharmacists were under the equivalent of a gag order if paying cash for medication would cost you less than your insurance company’s copay.
Say a medicine costs $10, but your copay for the drug is $20. Until recently, it has been common for the pharmacist to let you buy it through your insurance company, running you an additional $10.
In 2018, Congress introduced two bills to deal with this lack of transparency: the Know the Lowest Price Act of 2018 and the Patient Right to Know Drug Prices Act. Both bills received bipartisan support and were signed into law in October 2018 to take effect in January 2020.
Takeaway action step: For each prescription, ask your pharmacist for the cash price versus what the copay would be through your insurance plan.
Is there a generic version of my prescription drug?
Many drugs have two versions: the manufacturer’s branded version and a generic. The U.S. Food and Drug Administration (FDA) says the generic version must have the same active ingredient as the branded version, assuring it will be as effective.
Each Part D prescription drug plan will have its own “formulary,” which is a list of prescription drugs your specific plan covers. It typically ranks generic and branded drugs into a pricing structure with three-to-five tiers. Generics are usually in your plan’s least expensive tier.
Some prescription drug plans will only cover the cost of the generic version of a drug, but your doctor may have prescribed the branded version.
Takeaway action step: Unless your doctor indicated “dispense as written” on the prescription, ask your pharmacist if a generic version exists so you can benefit from the cost savings. If there is no generic, your pharmacist may be able to indicate a cheaper solution, such as an over-the-counter product. Or, if a less-expensive drug in the same therapeutic class can be used to treat your health condition, your pharmacist may be willing to contact your doctor directly to ask about a lower-cost alternative. In that case, your doctor would have to provide the pharmacist with a new prescription.
Do you know of any coupons, rebates or discount cards that could lower my prescription cost?
Your pharmacist might have access to cost-lowering coupons through the drug representatives who visit the pharmacy or through manufacturers. Besides prescriptions, these might also be available for different vaccines, such as the shingles vaccine, Shingrix.
Takeaway action step: Before you head to the pharmacy to fill a prescription, do a quick Google search to check for money-saving coupons and rebates. Also, use different apps (such as GoodRx, OneRx and RetailMeNot’s RxSaver) to understand how much the cost of that medicine might vary. That information could be helpful when you talk to your pharmacist. Just be sure your pharmacist is aware of any coupon, rebate or discount card you have brought with you early enough, well before you pay the final cost.
Are you aware of a Patient Assistance Program for me?
Pharmacists are exposed to people with all sorts of needs. They have virtually “seen it all,” which makes them a valuable resource in helping you in your cost-lowering efforts. For example, they may be aware of Patient Assistance Programs, where drug manufacturers help with the cost of expensive medicines or drugs you will be using for a long time because of a chronic condition.
Not only pharmaceutical companies provide these programs. Several programs are managed by states, such as Extra Help and the State Health Insurance Assistance Programs (SHIP). Or by nonprofit organizations, like The Assistance Fund, a disease-specific resource that helps individuals pay for out-of-pocket medical costs for treatment, including copays and health insurance premiums.
Takeaway action step: Ask your pharmacist if any of the different assistance programs might be available to you. Your pharmacist should also know if those programs are available to everyone, to people whose insurance does not cover a specific medication or only to people not enrolled in a Part D prescription plan.
Can you do a medication therapy review for me?
A medication therapy review can save you money by ensuring that your overall drug therapy is appropriate. It can remove any duplication, especially if you have multiple chronic issues, visit multiple doctors and fill prescriptions at multiple pharmacies. A review can also confirm the correct dosage and any conflicts that could cause adverse events.
Lastly, your pharmacist may also identify any gaps in your medications based on your existing health issues and your age. Any help in preventing future health challenges will save you untold money.
Takeaway action step: Ask your pharmacist if a medication therapy review is available to help you assess all your drugs. You would likely need to make an appointment and bring all your medicines (prescription, over-the-counter and nutritional supplements).
1 U.S. Senator Susan Collins. “Senators Collins, McCaskill, Stabenow Lead Bipartisan Group of Senators in Introducing Legislation to Prohibit ‘Gag Clauses’ That Cause Consumers to Pay Higher Prices for Prescription Drugs.” collins.senate.gov (accessed April 19, 2021).