Many people change their Part D drug plan during the Annual Enrollment Period (AEP) and find themselves with questions on January 1 when the new plan becomes effective. Or, being new to Medicare, don’t know the details of how the plans work. I thought I’d give you all some tips and tricks for what happens next.
When we completed your drug review during AEP and chose to move to a new plan, there was a reason, based on your medications, pharmacy and health conditions. But that was a month ago and often people forget what those reasons were. So, think about these tips, which apply to everyone.
DEDUCTIBLE: Most plans have a deductible, which is $445 this year. That amount is set by the govt and in most cases, even with a deductible, your plan was chosen because the overall annual costs are still lower. Also remember that on all plans, Tier 1 medications are exempt from the deductible and on many plans, so are Tier 2 medications. So unless you have brand named medications (or generics that are in Tiers 3-5), you will not pay a deductible.
PHARMACIES: Each plan has preferred and standard pharmacies. You can go to any pharmacy you like, but the costs will be lower on preferred pharmacies. So, when we spoke last month, I would have told you which pharmacy is the best to use on your particular plan. Sometimes, with generic medications, the cost is not much different between pharmacies, so you can use whichever is most convenient. You have access to the formulary and preferred pharmacies on the plan’s website or your personal portal, so you can look up that information when you are shopping for your prescriptions.
GENERIC MEDICATIONS: As a general rule of thumb, generic drugs are usually just as good as the original brand and are usually less expensive. So when you are working with your doctor to find a medication that works for your condition, consider using generics wherever possible.
BRAND NAMED DRUGS: Unfortunately, brand named drugs (usually Tiers 3-5) can be very expensive and will take you through the payments phases quickly during the year. If we knew in advance, we were able to find a plan with your particular medication in the lowest tier possible. But if you are newly prescribed these medications, it can be quite a shock. For these types of medications, there are a couple of strategies that you can use to lower costs:
Manufacturer Coupons: You can use one of the clearinghouse sites that find coupons that are offered by the manufacture or one of their foundations. Often these have financial qualifications, but I always tell people to call and talk to them regardless of whether you are low income or not. And you can link right to their website and/or application to apply. I like www.rxassist.org or www.needymeds.org
Pharmacy Coupons: One of the easiest sites to use to compare prices at different pharmacies and obtain coupons to use is www.goodrx.com . Sometimes you’ll find that a Tier 3 or 4 medication that is expensive on your drug plan can be purchased with a coupon, and not run through your plan. Most pharmacists use this tool and will tell you which medications are good, but you can always ask what the cash price is.
Doctor’s Samples: Some of the newer medications, or those that are used for cancer or other sever conditions are available through the doctor’s office as samples, or they can help you apply for financial help through those manufacturer or other foundations that offer assistance. They know where to go and how to apply, so don’t hesitate to ask at your doctor’s office.
Hopefully these tips and trick will help you maintain your sanity (at least related to drug costs) throughout 2021. We are always here to answer questions and help, if you need it. And remember that the drug plan runs through the end of the year and can be changed during the next AEP (Oct. 15 – Dec. 7, 2021).