Prescription drugs are not getting cheaper. Yet there are some ways people with Medicare Part D coverage can make their drug costs more affordable. Below is an overview of a few tips to save on drug costs.
Tip 1: Learn how Extra Help works and find out if you are eligible.
Extra Help is a federal program that helps you pay for some to most of the out-of-pocket costs of Part D Medicare prescription drug coverage if your assets and income are below specified limits. In California, and in most states, the 2018 monthly income limit is $1,538 for a single person and $2,078 for couples; (note these figures include a $20 disregard). If you live in Alaska or Hawaii, the income limits are higher: Alaska’s are $1,918 for single people and $2,593 for couples. Hawaii’s are $1,765 for single people and $2,386 for couples. Residents of U.S. territories are not eligible for Extra Help. If you are enrolled in Medi-Cal, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you automatically qualify for Extra Help. Even if your income or assets are above the specified limits, you could still qualify, because certain types of income and assets may not be counted. For help determining your eligibility, contact your local Health Insurance Counseling and Advocacy Program (HICAP).
The Extra Help program pays for your Part D premium up to a state-specific benchmark amount. (In California, the benchmark premium amount for 2018 is $35.51.) It also lowers the costs of your prescription drugs.
People with Extra Help have a monthly Special Enrollment Period to enroll in a Part D plan or switch between plans in 2018. If you delayed Part D enrollment, Extra Help also eliminates any Part D late enrollment penalty.
Remember that Extra Help is not a replacement for a Part D plan: You must still have a Part D plan to receive Extra Help. If you do not choose a plan, you will in most cases be automatically enrolled in one.
Tip 2: Use these cost-saving strategies
If you don’t qualify for Extra Help, there are other ways you can save on drugs costs. Here are a few ideas.
- Review your Medicare Part D plan annually during Medicare’s Open Enrollment period (Oct 15- Dec 7) to make sure it provides the most comprehensive coverage for your drugs at the lowest cost. Call your local Health Insurance Counseling & Advocacy Program (HICAP) at 1-800-434-0222 or Medicare at 1-800-MEDICARE (1-800-633-4227) to ask for assistance finding a plan. Alternatively, you can use the Medicare Plan Finder.
- Talk to your doctor about switching to generic drugs or less-expensive brand-name drugs. The Consumer Reports Best Buy Drugs (CRBBDs) website provides reports on various drug categories. Each report reviews both the prices and scientific evidence of the drugs’ effectiveness. It then analyzes and compares drugs within that category to create CRBBD recommendations.
- Ask your doctor for free samples of your prescriptions.
- Find out if using your plan’s mail-order pharmacy would cost less. Call your plan for details.
- Ask your pharmacist if the retail price is cheaper than the plan’s price. If it is, you can pay cash, and then submit the claim to your Part D plan for potential reimbursement.
- Apply for government or private programs that might reduce your drug costs. Some of these include: the California Prescription Drug Discount Program, the Department of Veterans Affairs, and TriCare for Life (see link above for information).
- Contact Patient Assistance Programs (PAPs) that cover your drugs. PAPs 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.
- Check the prices for your prescriptions at multiple pharmacies. Pharmacies such as Costco sell drugs for less than others (you do not need to be a Costco member to use its pharmacy).
- Check out the $4 generic drug programs at Wal-Mart and Target pharmacies.
Tip 3: Check out these websites with searchable databases looking up assistance programs for your specific drug(s)
The websites below contain searchable databases with information on prescription drug resources and financial assistance with prescription drug costs. Many specifically help you find patient assistance programs (PAPs) that offer your drugs.
- Partnership for Prescription Assistance (PPARx) offers a single point of access to more than 475 public and private PAPs, including over 200 programs offered by pharmaceutical companies. You can also access the PPARx by phone at 1-888-4PPA-NOW (1-888-477-2669). Sponsored by PhRMA (the Pharmaceutical Researchers and Manufacturers of America).
- RxAssist offers a comprehensive database of PAPs, as well as practical tools, news, articles and up-to-date information on how to access assistance from nearly 150 companies in receiving hundreds of medications. Searches can be performed on a multitude of variables: company name, brand-name drug, generic drug name and drug-therapy class.
- RxHope allows patients and their providers to apply for PAPs offered by hundreds of manufacturers, and to find information on programs offered by the state and federal government, as well as pharmaceutical companies. The Patient Assistance Information section of the site provides data about particular products and companies.
- NeedyMeds allows you to enter your medication name to find PAPs that pay for your specific medication. This site has an alphabetical list of over 4,400 prescription medications.
- MyGoodDays.org – Good Days is a non-profit organization that assists patients with chronic disease, cancer and other life-altering conditions obtain certain expensive, life-saving medications they need. Patients must meet certain income qualifications and have private insurance or a Medicare Part D plan. You can also reach them by phone at 1-877-968-7233.
- BenefitsCheckUp is a service of the National Council on Aging. It has an online screening tool that searches over 2,000 public and private benefits programs. Many of these programs can help certain qualified people ages 55 and older pay for some costs of prescription drugs, health care, utilities, and other essential items or services.