Saving money on Part D or how to minimize the coverage gap or “donut hole” in 2014

  • If you think you might be eligible for LIS (low income subsidy) “assistance” in paying for your Part D drugs explore with this with Social Security (800)772-1213 or Medicaid through your country social services divsion. Apply online at www.ssa.gov/prescriptionhelp. It is always appropriate to ask Social Security if you qualify for “Extra Help” particularly if your income situation changes;
  • Take advantage of VA or Tricare benefits if you are eligible;
  • Find out if you can save money using mail order programs through your plan;
  • Make sure you are using one of your plans “preferred pharmacies”.   The use of select pharmacies is a trend for the future. Shop and compare at different pharmacies, including “big box” stores.  If they have a pharmacy, membership in the store may not be required;
  •  Many drug manufacturers also offer assistance for people who take some of their expensive drugs.  Look at Patient Assistance Programs:  Call 800 633 4227 for manufacturer of specific medications;
  •  Drugs online or from Canada?  What you pay is not credited toward out of pocket max on Part D. However, be extremely cautious of acquiring medications from non-domestic sources as recent situations of improperly labelled or formulated medications have been discovered from foreign sources;
  •  Ask for free samples from your doctor;
  •  Can you alter your dosage or frequency?  This may work for some drugs, not others.  You must consult with your doctor or pharmacist before you consider this;
  • Are there other drugs similar to the ones you are taking that might be cheaper?  Consult with your physician;
  • Generics?  Have you tried a generic and it didn’t work.  Ask your pharmacist to try a different manufacturer — yes, generics can have many manufacturers;
  • Brand name drugs are covered @ 52.5% when you reach the coverage gap.  This makes it crucial that your Part D plan actually cover the drug.  Check formulary lists and check for pre-authorization, step therapy or quantity limits;
  • You can sometimes request an exception if your drug is not covered on your Part D plan.  Some plans will also allow you to request a lower rate tier on appeal;
  • Not enrolling in Part D is penny wise and pound foolish.  Penalty for not enrolling is 1% per month that you were eligible.  And, you run the risk of needing an expensive prescription with no coverage and no way to enroll until open enrollment;
  • If you’re over 65 and enrolled in an employer sponsored plan, make sure their Part D coverage is “creditable” or you may incur the 1% per month penalty;
  • If you’re on a Part D or Medicare Advantage plan and it’s working fine, pay very close attention at renewal to see if any new restrictions are being put on your drugs;
  • Make sure that you don’t just buy the cheapest monthly premium plan.  Make sure all drugs are on the plan “formulary”.  Also, check to see if your drugs are subject to any restrictions such as pre-authorization, step therapy or quantity limits (where applicable).
  • Your agent or broker can help you examine options to your plan, or you can search for alternatives by going to www.medicare.gov;
  • If you are taking multiple medications, and particularly if you are seeing multiple doctors for care, make certain one of those docs is taking the responsibility to review all of the medications you have been prescribed. Do not assume any of them is — ask! You could be taking medications that duplicate others, thereby imbalancing a treatment, or you might have drugs that conflict with each other. If you can reduce your medication list, you will save money.

Portions reproduced with permission of P. Davis

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