In addition to the good news on the prescription drug cost-saving changes happening due to the Inflation Reduction Act, here are some more tips on how to lower your drug costs or those of a loved one, as covered in this month’s Medicare Minute handout.
Apply for Extra Help
- You may qualify if you have limited income and assets. See the following page for details. Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. If you have Medi-Cal, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you automatically qualify for Extra Help. If you have Medicare but do not have Medi-Cal, SSI, or an MSP, see our eligibility chart to learn if you qualify for Extra Help. If you think you may qualify, you can apply through the Social Security Administration (SSA). Visit www.ssa.gov or call 800-772-1213 to learn more.
Talk to your doctor
- Ask your doctor if a generic drug could work for you. Generic drugs are often less expensive than brand-name drugs.
- Ask your doctor if they can provide you with samples of your medication. This is only a temporary solution.
- Ask your doctor for assistance with appealing. If your drug is not covered or is covered on a high cost-sharing tier, you may be able to appeal.
Learn about any Patient Assistance Programs (PAPs) that could help you
- Many pharmaceutical companies offer PAPs that provide free or low-cost drugs to qualified individuals. Each program has its own eligibility criteria and application process. Some provide drugs only if they are excluded from your Medicare Part D plan’s formulary, you are in the coverage gap or you are not enrolled in a Medicare Part D plan.
- Medicare can tell you which PAP covers your drugs, if you qualify and how to apply. Call 1-800-MEDICARE (1-800-633-4227) or visit the PAP page on Medicare’s website. Call the company that makes your drug for PAP details. Note: If a PAP pays for your drugs, that payment will not count toward cost-sharing (your TrOOP) in your Medicare Part D plan.
Ask your pharmacist to waive your copay
- While they are not allowed to do so routinely, your pharmacist may be able to waive copays on a case-by-case basis.
Look for charity programs that help pay drug costs
What is pharmacy & prescription drug fraud?
Just as it is important to get assistance with your drug costs, it is important to protect yourself against potential pharmacy or prescription fraud, errors, and abuse. There are many types of prescription drug schemes. Here are some examples of potential pharmacy or prescription drug fraud:
- A pharmacy bills Medicare for a medication that you did not receive or were not prescribed.
- A pharmacy gives you a medication that is different than what your doctor prescribed. For example, the pharmacy may give you too few pills. A pharmacy could also give you an expensive compounded medication when your doctor ordered a less expensive prescription.
- A pharmacy offers you “free” or “discount” prescription drugs without your doctor’s order, and then bill Medicare.
- A pharmacy offers you gift cards or money in exchange for you using their pharmacy.
- A pharmacy gives you expired drugs.
- A pharmacy automatically refills a prescription that you no longer need and bills Medicare, even if you do not pick up the prescription.
- A pharmacy routinely waives copays for all clients.
How can I detect pharmacy & presciption drug fraud?
Read your Medicare statements to check for errors or suspicious charges. Read your Medicare Summary Notices (MSNs) and Explanation of Benefits (EOBs) whenever you receive them. When you thoroughly read these statements, you can catch mistakes and suspicious charges.
Check that your medications are really what you were prescribed. After picking up a prescription from the pharmacy or having it delivered to your home, confirm that the medication does not look different and that you received the correct quantity.
If you notice anything suspicious with your Medicare statements or medications, contact our California Senior Medicare Patrol (SMP) at 1-855-613-7080. We can help report the incident to the correct authorities.
