Tips on Lowering Your Out-of-Pocket Cost on Prescription Drugs

Posted by Rolando Arellano, J.D.
Estimated Reading Time 2 minutes 26 seconds

Prescription medications can be a major expense for many Medicare beneficiaries. Even with Part D or Medicare Advantage drug coverage, out-of-pocket costs can add up quickly. Fortunately, there are several strategies that can help reduce what you spend on medications while still getting the care you need.

These practical tips can help you lower your cost on prescription drugs under Medicare.

Review Your Part D Plans Every Year

Medicare Part D plans are not all the same. Each plan has its own formulary, which is the list of covered medications, and its own pricing structure. The plan that worked for you last year might not be the most cost-effective option this year. Take time to review plans based on your current prescriptions. The Medicare Plan Finder tool at Medicare.gov can help you find the plan that offers the best coverage and lowest costs for your needs.

Consider Generic and Preferred Medications

Generic drugs are approved by the FDA and have the same active ingredients as their brand-name counterparts but usually cost far less. Ask your doctor if there is a generic version of your medication. You can also check if your plan has a preferred drug list. These are medications that the plan covers at a lower cost because they are considered more cost-effective options.

Use a Preferred Pharmacy Network

Many Part D and Medicare Advantage plans have a preferred pharmacy network. Using one of these pharmacies can significantly reduce your copayments. Some plans even offer lower prices through mail-order pharmacy services, which can be a convenient option for medications you take regularly.

Explore Prescription Assistance Programs

There are programs designed to help reduce the cost of medications for those with limited income or high drug costs. For example, the Extra Help program from Medicare offers financial assistance with Part D premiums, deductibles, and copays. Many pharmaceutical companies also offer patient assistance programs that provide discounts or even free medications for qualifying individuals.

Be Aware of the Medicare Coverage Phases

Understanding the phases of Medicare drug coverage can help you plan for and manage your medication costs. After meeting your deductible, you move into the initial coverage phase where you pay a copay or coinsurance. Finally, catastrophic coverage kicks in after you have paid a set amount out of pocket, reducing your costs again. Knowing where you are in this process can help you budget.

Talk with Your Doctor About Alternatives that May Help You Maximize Your Budget

Doctors can often prescribe lower-cost alternatives or help you find medications that are covered more favorably under your plan. If a particular drug is not on your plan’s formulary, your doctor may be able to request a formulary exception. Open communication with your healthcare provider is key to managing your prescription costs effectively.

Use Medicare’s Resources

Medicare offers tools and resources to help beneficiaries make informed choices. You can use the official Medicare website to review drug prices, view plan formularies, and learn about savings programs. Staying informed and proactive can lead to lowering your out-of-pocket costs over time.

Prescription drug costs do not have to strain your budget. With the right strategies and support, you can reduce out-of-pocket expenses and still access the medications you need. If you would like help reviewing your current Medicare coverage or exploring more ways to budget, contact our office to schedule an appointment with a licensed insurance agent. We are here to help you make the most of your plan.