Reduce Your Prescription Drug Costs | Lifestyles

If you’re using Medicare Part D to help cover your prescription costs, Medicare has recommended five ways to lower your costs. I will summarize them below and add another recommendation.

  • Consider switching to a generic prescription. If you’re using an expensive brand name prescription — the costs of many have increased recently — ask your doctor if there’s a generic alternative that will meet your needs. You can also determine if using a mail-order pharmacy will reduce your costs.
  • Find a drug plan that offers additional coverage within the Medicare drug coverage gap. When you enter the drug coverage gap, the cost of your drugs increases. There may be a plan that lowers your costs in the gap. However, you need to consider whether it carries a higher premium that outweighs the benefits. Medicare.gov, a website operated by the Centers for Medicare and Medicaid Services, has a page that allows you to explore plan options and determine if there is one that will lower your costs.
  • See if your drug manufacturer has a pharmacy assistance program. Several manufacturers offer assistance programs, depending on your financial situation, which will reduce your costs. For example, readers who use Eliquis and Dexilant have found programs that significantly reduce their costs. Contact your drug manufacturer to determine if there is an assistance program for your expensive drugs. Medicare.com also has a web page to help you search using the drug name as a keyword.
  • Take advantage of a state pharmaceutical assistance program. Medicare.gov can help you find out if your state has an assistance program that will lower your drug costs.
  • Ask for additional help. Medicare and Social Security offer families with limited resources a way to get help that will reduce drug costs. To learn more, go to www.medicareinsurance.com/what-is-medicare-extra-help. Your level of income and the level of certain financial resources will determine your eligibility. If you qualify, your drug costs will be reduced and, in some cases, your costs for a specific drug may be eliminated altogether.

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The income limits in 2022 were $20,385 for an individual and $27,465 for a married couple. For financial resources, the ceilings in 2022 were $14,610 for an individual and $27,465 for a married couple. Applicable resources are: money in checking or savings accounts, and stocks and bonds. What doesn’t count is the value of your home, a car, your burial plot, up to $1,500 for burial expenses, and furniture or other household items. According to the Social Security Administration, the value of these benefits can reach $5,000.

You can apply using a paper application, by dropping it off at your local Social Security Administration office, or by phone. You can call 800-772-1213 to apply by phone or get more information. I called this number and the representative I spoke with confirmed that you can apply for this program over the phone.

  • Request a limitation exception. Several readers have suggested that they have successfully reduced their Part D drug expenditures by using the “prescription exception” process.

Suppose you want to be prescribed a drug that is too expensive for you in your Part D plan or not currently available in your Part D plan. You can ask your doctor to document the need for this drug specific, indicating why another cheaper drug is not effective. With this documentation from your doctor, you can then file an exception request with your Part D representative. One reader reported that by using this process, the monthly cost of her Eliquis prescription was reduced from $700 per month to $48.

Program details can be found on the Centers for Medicare and Medicaid Services website, CMS.gov. Search for “CMS Prescription Exceptions”.

Elliot Raphaelson welcomes your questions and comments at raphelliot@gmail.com.

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