Lower prescription drug costs
If you use Part D of Medicare to help cover your prescription costs, Medicare has recommended five ways to lower your costs. I’ll summarize them below and add a further recommendation.
Consider switching to a generic prescription. If you are using a name-brand prescription that is expensive — the costs of many have increased recently — ask your doctor if there is a generic alternative that will meet your needs. You can also determine whether using a mail-order pharmacy will reduce your costs.
Find a drug plan that offers additional coverage in the Medicare drug coverage gap.
When you enter the drug coverage gap, the cost of your medications increases. There may be a plan that reduces your costs in the gap. However, you have to determine if it carries a higher premium that outweighs the benefits. Medicare.gov, a website operated by the Centers for Medicare & Medicaid Services, has a page that allows you to explore plan options and determine if there is one that will reduce your costs.
See if your drug’s manufacturer has a pharmacy assistance program. Many manufacturers offer assistance programs, based on your financial situation, that will reduce your costs. For example, readers who use Eliquis and Dexilant have found programs that reduce their costs significantly. Contact your drug manufacturer to determine if there is an assistance program for your expensive drugs. Medicare.com also has a webpage to assist your search using the drug name as a keyword.
Take advantage of a state pharmaceutical assistance program. Medicare.gov can help you find out if your state has an assistance program that will reduce your drug costs.
Apply for extra help. Medicare and Social Security offer a way for families with limited resources to get help that will reduce drug costs. To find out more, go to www.medicareinsurance.com/what-ismedicare-extra-help. Your income level and level of some financial resources will determine your eligibility. If you are eligible, your out-of-pocket drug costs will be reduced, and in some cases, your costs for a specific drug can be completely eliminated.
The income limit in 2022 for an individual was $20,385; for a married couple the limit was $27,465. For financial resources, the limit in 2022 for an individual was $14,610; for a married couple, the limit was $27,465. The resources that are applicable are money in checking or savings accounts, and stocks and bonds. What doesn’t count is your home value, one car, burial plot, up to $1,500 for burial expenses, furniture or other household items. According to the Social Security Administration (SSA), the value of these benefits can be up to $5,000.
You can apply using a paper application, filing at your local SSA office or by phone. You can call 1-800-772-1213 to apply by phone or obtain more information. I called this number, and the representative I spoke with confirmed you can apply for this program by phone.
Apply for a prescription exception.
Several readers have suggested that they have been successful in reducing their Part D drug expenses using the “prescription exception” process.
Suppose you wish to be prescribed a drug that is too expensive for you in your Part D plan or is currently unavailable through your Part D plan. You may ask your doctor to document the necessity of that specific drug, indicating why an alternate cheaper drug is not effective.
With this documention from your doctor, you can then make an exception request with your Part D representative. One reader indicated that, using this process, the monthly cost of her Eliquis prescription was reduced from $700 per month to $48.
Details of the program can be found at CMS.gov, the Centers for Medicare & Medicaid Services website. Search on terms “CMS prescription exceptions.”