By Carolyn Spence Cagle, Ph.D., RNC-E
Retiree concerns about reaching the Medicare D “donut hole” (hole) and affording cost of medications for chronic or acute illness mandate discussion about ways to save money on drugs. Approximately 25% of consumers reaching the hole stop taking medications because they cannot afford them with other essential life expenditures. This decision poses a serious problem for those whose health depends on consistent medication. Although the Affordable Care Act of 2010 planned to eliminate the hole by 2020, consumers will likely pay about 40% of generic (non-brand name) and brand name drug costs this year due to the hole (www.medicare.gov).
The 2018 hole amount occurs when a retiree expends between $3310.00 and $4850.00 on drug costs. Medicare D (prescription) plans vary in ways they handle initial drug deductibles and coinsurance/ copayments so people differ in whether or when they reach the hole. Carefully examine your plan for how it determines drug payment relevant to the hole.
How can you control your drug costs in a time of increasing drug prices and the continuing hole in 2018 and 2019? Here are some ideas to help you:
- Seek help for prescription costs to avoid the hole through a Medicare/ Social Security program called “Extra Help” (see Medicare & You 2018,
pp. 97-102); this program requires evidence of a general income of less than $18,090/year (single person)
or $24,360 (couple) (single or couple resources are also part of the calculation).
- Pursue other options for prescription cost help through State Pharmacy Assistance Programs (SPAPs) (the back cover of your Medicare & You 2018 has the phone number for TX or relevant state or call 1-800-MEDICARE
for assistance); section 8 of Medicare & You 2018 book has additional valuable information about drug help options. More drug assistance programs may be found at the Partnership for Prescription Assistance (www.PPARx.org, 1-888-4PPA-NOW) for middle- income seniors.
- Become Medicare and Medicaid “dual eligible” and avoid the hole (met criteria for both federal programs) (see Medicaid & You 2018, pp. 100-101).
- Use coupons at major discount stores and pharmacies, websites or through Smart phone apps to find cheaper drugs (www. goodrx.com allows drug cost comparisons at local pharmacies); other good Web sites include www.lowestmeds. com, CRBestBuyDrugs.org, and
HealthWarehouse.com to gain information on quality/safety of medications and “fair pricing” information to negotiate lower prices at local pharmacies; drug co-payment coupons often exist for more expensive brand-name drugs to considerably cut the costs of those (www.medscape.com).
- Read widely in consumer magazines on the medication cost issue. A recent Consumer Reports article compared some medication costs at various pharmacies and stores (“Save Money on your Meds,” January 2016) and found HealthWarehouse.com had the lowest prices. MAKE SURE online pharmacies you use operate in the U.S. and show the VIPPS (“Verified Internet Pharmacy Practice Site”) symbol to insure your privacy and truthful and quality products from legitimate companies. Carefully read terms of ordering from those sites to be fully informed with using these companies. Quality VIPPS sites will require you to submit a written prescription for filling of a medication.
- Ask pharmacists for discount cards to save additional money for medications: sometimes your Medicare program does not allow these discounts, but it cannot hurt to ask!
- Try new medications recommended by your doctor
(ask for drug samples or a 14-day supply) before you spend money at the pharmacy for a 30-day or more supply (average doctor receives more than $20,000 per year in drug samples! [www.newsmax.com]); you may be able to get discounts on a 30- day supply at www.multi-pillsupply. com (some pharmacies offer 30-day supply of a drug through an online discount); ordering 90-day supply of your medication through a state licensed VPPS online pharmacy also can save money.
- Use generic drugs when possible; these generally have the same biological properties as more expensive brand-name drugs but cost 80-90% less; check with your doctor about ordering generic drugs covered on your drug plan; many drug plans cover generic drugs on the first tier (level) of drug coverage, the least expensive tier (your drug co-payment is lowest); some on the first tier do not require a co-pay from you!
- Use generic drugs from large pharmacies (Wal-Mart, Target, Walgreens, Rite Aid, CVS, etc.) if their medication pricing seems competitive; I fill most prescriptions at Wal-Mart because it is my “preferred pharmacy” on my Medicare Advantage plan and saves me money; I get a 30-day supply of one medication for $4.00; another medication costs me $10.00 for a 90-day supply which actually lasts twice as long because I cut each pill in half to meet my dose need; check with your doctor to make sure cutting pills to save money meets your health needs (not all pills can be cut to be effective).
- Shop around; be aware that drug costs vary widely in different cities and locations; according to a recent Goodrx document, New York City consumers paid 20% more than the national average for 500 commonly prescribed drugs for the period ending April 2018; consumers in Dallas, however, paid almost 17% less than the national average in that same period; differences in cost of living may account for these differences and large numbers of “big box” stores (e.g., Wal Mart) may offer popular and generic drugs for cheap prices ($4.00 for a 30-day supply) in some locations;
- Use Goodrx coupons; go to that website and find the price of your drug at local pharmacies to choose the place to get the drug cheapest by using a Goodrx coupon; Goodrx users saved an average of 59% off the drug retail price, sometimes allowing them to pay less than their insurance co-pay.
- Explore cost savings with drug discounts programs offered by CVS, Walgreens, and other local pharmacies (Walgreen’s program costs $20.00/year; one TCU retiree offers the AARP discount may work at Walgreens without program membership).
- Use over the counter (OTC) medications instead of prescription drugs to address a health care issue (e.g., Tylenol 650 mg may work just as well as more expensive Celebrex).
- Carefully read your drug plan to understand drugs covered by your plan (and expected 2018 changes) and the cost to you; speak to your doctor about prescribing those drugs initially before moving to more expensive higher tier drugs (a concept called “step therapy).
- Seek to find the best pharmacy for your medication and financial needs; develop a close relationship with your pharmacist that will advocate for your needs and values a loyal consumer base; seek to fill all prescriptions at that one pharmacy to track medication allergies and interactions that may affect your well- being.
- Work with your doctor for better understanding of your medication regime that influences your medication use choices: ask “why do I need this medication, is there a way I can simplify my medication regime, how long do I need to take this medication”? AND, when you pick up a prescription, read printed drug information to identify reasons to take the drug, side-effects, correct dosage, interactions with food or other medications, and actions to take if you miss a dose.
- Don’t take drugs you don’t need; other interventions may work and be much cheaper and with fewer side effects (e.g. high blood pressure – try meditation for managing this) (Carr, 2017).
- Carr, T. (2017, September). Too many meds? Consumer Reports, 82(9), 25-39.
- Goodman, B. (2015, November 20). As Rx prices rise, more say meds are affordable. Retrieved November 27, 2015 from http://www.medscape. com/viewarticle/854789_print.
- Marsh, T. (2018, July 6). Here are the most, and least, expensive cities for prescription medications. Retrieved July 12, 2018 from http://goodrx.com.
- Save money in Medicare in 2016 (2015, November). AARP Bulletin, 56(9), 4. Save money on your meds (2016, January). Consumer Reports, 81(1), 13-17.
- U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) (2017. Medicare & You 2018. Baltimore MD: U.S. Government Printing Office (CMS Product No. 10050-16).