Lower Prescription Drug Costs

Two different methods depending on your income level

Lower Income

 The government has a program called "Extra Help" or also known as  "LIS" (Low income Subsidy) that can lower your Medicare prescription drug costs. 

But first of all please understand that Extra Help/LIS does not replace your Medicare Prescription Coverage Part D plan. You still have to have Medicare Prescription Coverage Part D in your plan whether you qualify for Extra Help or not. Extra Help is in addition to your Medicare Prescription Coverage Part D.

 But what it does is lower your copays even further than what they would otherwise be under your Part D. This means that even if your Part D plan for example says that a certain expensive brand name drug has a copay of $40, you would not have to pay that $40 if you have Extra Help. Instead, you may only pay somewhere between $3 and $12.

At the pharmacy, you would show them your Part D plan card AND your proof of Extra Help. That proof is usually a Purple Letter that the government sends you.

How do you qualify for Extra Help?

If you have Medicare and Supplemental Security Income (SSI) or Medicare and Medi-Cal you automatically will get the extra help.

If the above paragraph does not apply to you, then you may still qualify if you meet the following conditions (and you  apply and get approved).

  • (Year 2017 figures) Your combined savings, investments, and real estate (property you don't live in)  are not worth more than $27,600, if you are married and living with your spouse, or $13,820 if you are not currently married or not living with your spouse. (Do NOT count your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts or back payments from Social Security or SSI.) If you have more than those amounts, you may not qualify for the extra help.

To apply for Extra Help, contact Social Security or follow this link to enroll online socialsecurity.gov/i1020 or by calling (800) 772-1213. Extra Help can save you a lot of money on drug costs. 

Moderate to Higher Income
(see "Lower Income" on this page if it is more applicable to you)

The first thing to note is that there are some Part D prescription plans that have a deductible. It's almost never necessary to get one of those plans. There are really good no-deductible plans to choose from that cost anywhere from nothing (yes nothing) to about $30 per month). That right there will save you from a $400 deductible.

The second thing is not something everyone wants to hassle with but I provide this to you in case you do.

There is a website called GoodRx.com.

 

How can GoodRx help you save if you're already insured?

Your copay may not be the lowest price, or in case your insurance plan doesn't cover the drugs you need.  You'll be surprised to learn that there are many discounts available that will sometimes provide lower prices than your copay, and some pharmacies have special generic priced medications for $4 or even free without insurance.

Typically, health insurance provides you with 2 benefits: A discounted price for your medications and set co-pay for your medications.

Here are 3 things to consider when deciding whether to fill your prescription with your insurance or GoodRx:

  1. Is this drug covered by your plan? If so, how much will it cost?

  2. Insurance companies use “formularies” which list how much they will pay for a specific prescription. Formularies divide drugs into “tiers.”. For many brand name drugs, your plan may cover just a percentage of a negotiated price. Check your insurance company's website to see if they provide pricing, then compare your copay to the price GoodRx lists. You may be able to save money by using GoodRx and paying cash for drugs that are not “preferred.” 

  3. Can GoodRx beat your co-pay?

Don't be surprised if local and mail order prices are well under your co-pay. Some generic copays can be $7 to $10. Many, many generic drugs can be bought for less than $10. Why pay $10 when you could pay $4?

Can I use GoodRx if I have insurance or medicare?

Yes! If you have insurance or Medicare, GoodRx and GoodRx Gold can still help you control your prescription drug costs and find prices that are lower than your typical co-pay.

You can use a GoodRx discount instead of your prescription insurance or Medicare if the cost is lower. GoodRx cannot be used in conjunction with insurance or to lower your co-pay. You use either one at any time, but not both at once for the same prescription.

If you choose to use a GoodRx coupon, just ask the pharmacist not to run your prescription through your insurance or Medicare (they do this all the time). Ask that they use the coupon to process the transaction instead. If your pharmacist has any trouble using the discount, ask that they call the phone number on the coupon—someone from the help line will be able to help them process it correctly and can answer any questions.

 

Using GoodRx.com can potentially save you from reaching the "Donut Hole" or Rx coverage gap. which means you will continue to pay less. The cost of drugs purchased under GoodRx will not count against your coverage limit - thus keeping you out of the donut hole longer.