IBM Medicare OneExchange Lowering Prescription Drug Copay Cost

We are almost half way through the year and often at this point Medicare recipients encounter cost or coverage problems for new prescriptions or price increases on existing prescriptions that significantly drive up the cost of their medications.  Here are a few suggestions on how to cope with unexpected drug costs:


1. Don't assume a prescribed drug is the only drug available to treat your condition.  If a prescription is expensive, ask your doctor if there is a generic alternative or another drug that will do the same thing.  Better still, show the doctor your drug plan's entire formulary and ask if any of those drugs will be suitable for your condition.

2. If there is no flexibility in the drug you need to treat your condition but the cost is high or there was a price increase, try to appeal to your plan for a pricing exception and/or ask them to lower the pricing tier for the drug for the rest of the year.  If you get an exception or a tier change it will only last until the end of the year.  Be sure to pick a "better" part D plan during fall open enrollment.

3. Make sure you are getting your drugs from a "best price" pharmacy if you buy drugs from a pharmacy.  Ask the insurance plan what pharmacies provide the best prices for their plan.  These are called preferred pharmacies.  You might have to travel a few more miles to get a prescription filled but the price difference can be significant. Even if there are no preferred pharmacies in your plan, the prices will often vary - particularly for independent pharmacies - but also for the chains so ask different pharmacies in your area what they will charge to fill a prescription before you fill it.

4. Ask your pharmacy if there is a  prescription discount card that can provide a lower copay. However, if you do use a prescription discount card, the cost of that prescription will not be included in any doughnut hole calculations.

5. Ask your local pharmacy if they will provide a "better price".  Some pharmacies will sell you drugs at their cost if you do a lot of business with them - particularly if they are not part of a big chain.  Again, if you don't use your insurance to buy a drug, those costs are not included in doughnut hole calculations.

6. Many older people shy away from mail order suppliers and prefer to use local pharmacies.  Give mail order a try! Mail order (if available through your current plan) - often significantly lowers your copay.  However, you will likely have to buy larger quantities of drugs to get the lower price. If you can afford the cash flow it is worth it.

7. EVERY YEAR in October, look on plan finder in medicare.gov or call 1-800-MEDICARE and ask them to help you find a better plan