As prices skyrocket on everything else we buy, they also increase on our prescription medications. And for many, that can be enough to break an already-tight budget.
Even if you have a Medicare Part D prescription drug plan or Medicare Advantage plan with drug coverage, what if you can’t afford the copay the plan charges?
The most obvious way to reduce prescription drug costs is to ask your doctor if a generic drug is available to replace a brand-name drug. (And if not, ask if there is another drug with a generic that might have the same effect.) Or look into buying in greater volume, say for 90 days instead of 30 days.
Fortunately, a wide range of other possibilities exists where, with some research, you might find a significant difference in the cost of your prescription drugs. And these possibilities could be used inside or outside of your insurance plan.
One warning: If you purchase drugs outside your insurance plan, remember that you will not be contributing to your plan’s annual deductible or out-of-pocket maximum. Also, when comparing retail pricing to your insurance copay, remember that your Part D prescription drug plan may not have the best coverage for that drug. The formulary (drug listing) for another plan could be much better; if so, you should consider changing prescription plans during the next enrollment period.
Takeaway action step: To find the plan with the lowest total cost for your medications, use the Medicare Plan Finder or ask your local State Health Insurance and Assistance Program (SHIP) office for help.
So just how much can prices vary? A 2018 Consumer Reports study contacted 150 pharmacies nationwide to check on retail prices (not insurance prices). These included chain pharmacies, supermarket drugstores and independent pharmacies. The study found that a 30-day supply of five commonly prescribed generic drugs ranged from $66 at an online pharmacy, $105 at Costco as a non-member, and closer to $900 at CVS and Rite Aid. (Those differences may not be the same today.)
Finding prescription assistance programs
Resources such as the Pharmaceutical Research and Manufacturers of America (PhRMA) work to make medicines more affordable through access to tools such as the Medicine Assistance Tool (MAT). It can be used whether or not you have insurance. MAT is a search engine sponsored by many of the larger pharmaceutical companies that will try to match you with the patient assistance program that can help you obtain your medication affordably.
Takeaway action step: Go to the MAT website. Enter the medications you need help accessing, plus your information. The program will list the resources available to you based on your provided information. The Medicare website also provides a search tool for pharmaceutical assistance programs. You simply enter the name of your medication and click on “Find Programs.”
Watch out for groups that market themselves as advocacy services that help you apply to pharmaceutical companies for patient assistance programs. They may charge a one-time enrollment fee, plus a monthly fee determined by the number of medications they help you with.
Using prescription discount cards
NeedyMeds is another example. (The site claims over $325 million has been saved using the card.) You can access a card for savings up to 80% on out-of-pocket medication purchases for a small donation of $5, with a 30-day money-back offer if you’re unhappy with the card. In addition, you can search on the site for pharmacies near you that accept the card and use the drug pricing calculator.
Takeaway action step: Visit the various websites mentioned above, among others. Once you find the best local price online for the medication in question, you fill your prescription at that pharmacy using a free card, a downloadable coupon or a mobile app provided by the discount card program. Some of these programs also provide online pricing for home delivery of your medication.
Finding a coupon for your medication
Coupons, usually good for one use, are available from several sources, starting with your doctor, your pharmacist, your drug’s manufacturer and the internet. Internet Drug Coupons is one example. There may be an overlap between coupons and prescription discount cards, as companies may offer both.
Takeaway action step: Type the name of your medication with the word “coupon” into a search engine (such as Google, Safari or Edge) and see what coupons or other discounts might be available.
Calling up local, independent pharmacies
Independent pharmacies can often be much less expensive than large chain pharmacies. So before buying anywhere, consider calling a handful of independent pharmacies near where you live to check on their retail price. It could be less than your insurance copay.
Checking prices wherever you have a buying club membership
Chains like Costco and online marketers like Amazon often offer pharmacy services with deep discounts to their members. Check if the difference would justify becoming a member. But if you already belong, you may as well check the member price on your prescriptions.
Researching prices on online pharmacies
Online pharmacy prices can be favorable, but be sure the site has a physical location somewhere in the U.S., sells only FDA-approved prescription drugs and requires a qualified doctor’s prescription.
Takeaway action step: The National Association of Boards of Pharmacy website has a search engine to help you find accredited digital pharmacies.
Reaching out for Medicare prescription assistance
Extra Help is a Medicare program that helps low-income beneficiaries with Medicare Part D (prescription drug coverage) to pay premiums, deductibles and copays. Social Security estimates it could be worth about $5,100 per year to someone eligible.
Takeaway action step: Call Social Security at 1-800-772-1213 to ask about applying for assistance, or visit the Social Security website page regarding Extra Help With Medicare Prescription Drug Plan Costs.
Checking if your state has assistance programs
Many (but not all) states offer help with prescription drug costs. In some cases, assistance is tailored to specific groups, such as people living with HIV or AIDS.
Takeaway action step: Visit Medicare’s page with a search function for state-based help through a State Pharmaceutical Assistance Program.