What Drives High Prescription Drug Costs and What You Can Do, Part 2

prescription drug costs
hundreds of prescription pills in a pile

High Prescription Drug Costs

In Part 1, we talked about some factors that drive the skyrocketing costs of drugs. But, now that open enrollment has come and gone and you’re into your new Medicare Advantage Prescription Drug plan (Part C) or Stand Alone Prescription Drug Plan (Part D) year, how do you combat those costs? Let jump right into it.

Generics vs Brand

First, if your physician prescribes a high cost drug, ask if there is a lower cost alternative you can safely take. Alternatives may be in the form generics and will save you money over the cost of brand drugs. Generics have slight changes in formulations, usually in the form of fillers, but are just as effective as Brand counterparts.

Your Mega Pharmacy May Be Driving Up Your Prescription Drug Costs

Second, check to see which pharmacies are “Preferred” pharmacies according to your plan. It is a common misconception that certain mega retailers are always cheapest. You may find that getting your prescriptions where you regularly shop is costing you additional money. If you prefer to only shop a specific location, that’s fine as long as you’re aware of your options.

Mail Order Option

Third, many MAPDs or Part D plans will offer a Preferred Mail Order option. This option can be extremely cost effective. Preferred Mail Order is, typically, used with medications you take long term, medications you will take for at least 90 days. Make sure you use the Preferred Mail Order Pharmacy covered by your plan to get the full benefit.

Prescription Drug Patient Assistance Programs

Fourth, if you find yourself taking a high price medication, go to the manufacturer’s website to see if there are assistance programs. You will have to meet specific criteria, set by the drug manufacturer for that medication. If there is a program and you qualify, you will likely have to fill out and file an application with the drug manufacturer. If you do not have access to the internet or are unable to find information, contact the manufacturer directly. They will be able to provide you any program information including how to apply if assistance is available.

Your Pharmacist Is Your Friend

Fifth, get to know your pharmacist and pharmacy staff. They are, usually, happy to help. Don’t be afraid to ask questions. Ask how much a prescription would be if you purchased it outside of your insurance. You may be surprised to find you would pay less than your co-pay in some instances. Publix, as an example, offers some generic antibiotics, diabetes, and blood pressure medications at no cost, with a valid prescription. Also, some prescriptions may have an over the counter alternative. This is most common for prescribed vitamins and other supplements.

For high price medications, take the time to visit discount drug websites, like GoodRx, which may provide coupons. But, be aware, prescription drugs purchased outside your insurance plan usually do not count toward any Out of Pocket costs associated with your plan. In other words, doing this may affect how soon you enter the Donut Hole and how long you stay in it.

Before purchasing any prescription drugs outside of your plan, contact your plan directly and find out how this will affect your coverage. Will the purchase be counted towards your Out of Pocket costs? Can you submit receipts to your plan for inclusion? If the purchase will not count towards your Out of Pocket costs, how will this affect you in the Deductible, Initial Coverage, Gap and Catastrophic phases?

Extra Help With Prescription Drug Costs

Last, if you think you may qualify for financial assistance of some sort, apply for it. I can’t stress this enough. If you or someone you trust is comfortable using a computer, a good website to check out is BenefitsCheckUp. Answering just a few questions will give you a list of any programs that you may qualify for. Beyond this, check with faith-based and charitable organizations to see if they can provide help, even if it’s on a month to month basis.

Most importantly, trust in the Lord.

Author: Lesa Inglis