Ask The Medicare Specialist

QUESTION:

Hello Aaron, I’m using Question from Christine: my Stand-Alone Part D prescription plan for the first time to get my Combigan eye drops. There’s a woman at the pharmacy who said I have a deductible and my three-month supply would cost $267.12. I can’t recall what my deductible was for my drug coverage. Can you advise please?

ANSWER:

Christine is a new client. Her Medicare Supplement and Stand-Alone Part D prescription plan went into effect on January 1st of this year. When we finish enrolling someone like Christine, the last advice we give is, “Here’s the most important thing to remember. Don’t ever hesitate to reach out to us if you have questions or concerns even remotely related to your policies. There’s always someone available who can help.”

Christine followed those directions and it’s going to save her a good deal of money. Most Stand-Alone Part D prescription plans do indeed have a rather large deductible on Tiers 3, 4, and 5 drugs of $545 in 2024. Her Combigan is a Tier 4, even in generic form. I immediately told her not to pick up that prescription because it’s far less expensive using a Canadian pharmacy. In fact, a 90-day supply of the generic is only $47 including shipping. She will spend less than $200 for the year versus $750 using her insurance. This is because with her Part D plan Christine must pay full cost until she has met her $545 deductible and then pay 48% of the retail cost the remainder of the year.

There are lots of medications which can be purchased out of Canada at tremendous savings, and we have hundreds of clients who take advantage of that. Eliquis is probably the number one most prescribed brand name drug in the US. 5mg, the common dose, can be bought out of Canada in brand name form for as little as $140 (shipping included) for 168 tablets, just shy of a 90-day supply. Although not available from US pharmacies yet, the generic version of Eliquis, Apixaban, was approved by the US Food and Drug Administration in 2019 and is being taken by people all over the world. It only costs $77 (shipping included) for 200 5mg tablets! People on Medicare Stand Alone Part D plans who take Apixaban save from $1,100 to $1,500 per year versus using their insurance to buy brand name Eliquis. Other common medications that many of our clients get out of Canada include Jardiance, Advair, Restasis, Januvia, Breo, Dexilant, Farxiga, Xarelto, Premarin Cream, and more.

Another good way to save money on generic drugs that are tiered as if they were brand name is to use Good Rx coupons, Cost Plus Drugs which is a national mail order pharmacy, and a local Pittsburgh area pharmacy, Blueberry in West View. Our Prescription Drug Caseworker, Tony DiRoma, who is tasked with helping our clients find financial relief for high prescription costs is a huge fan of Blueberry Pharmacy and he has referred many clients who have expressed how happy they are working with them and the money they’re saving. The owner provides generic medications at his cost, plus a small dispensing fee. Prescriptions can be filled in person or via mail. Please keep in mind that none of these options are intended to replace Part D prescription coverage and there is no savings versus not using insurance on brand name medications.

The easiest way to save on medications is to get PACENET which is a Pennsylvania program funded by the state’s lottery proceeds. PACENET limits the cost of any medication to just $15 for a 30-day supply. There are income limits of $36,978 for a single individual and $48,957 for a married couple. Gross Social Security is counted towards this figure. However, assets are not included so those with savings, stocks, bonds, property etc., still qualify as long as their earned income plus gross Social Security is under those amounts.

Obviously, many people won’t qualify. For those who don’t and are taking expensive brand name drugs not available from Canada, something called Patient Assistance Programs (PAP) are available. These are funded by the drug manufacturers themselves and have much higher income limits, from 300% to 600% of the Federal Poverty level. Just this week a client of mine was taking Dupixent, which retails for over $3,000 for a 30-day supply. She was going to be forced to spend almost $4,000 out of her pocket in 2024. However, Tony found a PAP that had an income limit of $120,000 for a married couple. She qualified and will now receive Dupixent at no cost! And the best part about it, it’s Big Pharma, not taxpayers footing that bill.

Clients of The Health Insurance Store always have our experienced staff as a resource to help any situation where they have concerns about out of pocket medical and prescription expenses, erroneous bills, or claim denials. Just like consultations, theses services are always no cost for those who allow us to enroll them in an individual ACA, Medicare, or employer group health insurance plan.