INSURANCE

Q: Why do my prescription costs change? I never know what I’ll have to pay. A: Your prescription drug costs can change for a number of reasons. The first thing you need to consider is whether you or your doctor has made any changes since the last time you refilled your prescription.

For example, are you using a different pharmacy? Have you switched to a pharmacy that is not in your plan’s network? Or, did your physician change the dosage strength or number of pills you’re taking each day? Any of these can affect your cost.

Another consideration is whether the manufacturer increased the cost of the drug. If you are paying a percentage of the cost and the cost goes up, both you and your prescription drug plan will be paying more. The most common reason for prices changing will be because you have moved into a different stage of your Medicare Prescription Drug coverage. There are four different coverage stages and what you pay will depend on what stage you are in. The four stages are:

Deductible stage: During this stage, you will have to pay the full cost of your prescriptions until you meet your deductible. Check with your plan for the amount of your 2017 deductible.

Initial coverage stage: Once you meet your deductible, you will pay a portion and your plan will pay a portion of the cost of prescriptions. You will continue in this stage until your total out-of-pocket drug costs (what both you and your plan pays) reaches $3700 for the year..

Coverage gap: This stage is commonly referred to as the “donut hole.” In 2017 you can expect to pay 51% of the cost of generic prescriptions and 40% of the cost of brand name drugs.

Catastrophic coverage: In 2017, you enter the catastrophic coverage stage once your out-of-pocket costs for prescription medications reach $4950. At that point, you will pay either 5% coinsurance on the cost of covered drugs or a co-pay of $3.30 for covered generic drugs and $8.25 for covered brand name drugs, whichever is greater.

While many prescription drug plans include both preferred and non-preferred pharmacies, you will probably pay less at preferred pharmacies.

The best person to ask about any change in your prescription cost is your pharmacist. They will be able to pinpoint why your costs have changed and what you can expect to pay in the future.

If you have questions concerning life, health, Medicare supplements, Medicare Advantage plans or other insurance, give me a call at 440-255-5700 or email me at Lmutsko@mutskoinsurance.com. Laura Mutsko Mutsko Insurance Services, LLC 6966 Spinach Drive, Mentor, OH 44060 440-255-5700 www.mutskoinsurance.com