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How Can I Avoid the Medicare Donut Hole?

Even with a Medicare Part D Prescription Drug Plan, Medicare beneficiaries throughout the country find themselves struggling with the cost of their prescriptions. If you are one of the thousands of Medicare beneficiaries looking to save money on your medications, these tips may help you.

1. Make Sure You Have the Right Drug Plan

Part D Drug Plans are offered by a variety of insurance companies and other private companies approved by Medicare, and each company has its own drug formulary. The formulary determines what medications are covered and how much your copay will be, and it can change every year. This means that even if your medications don’t change, if you keep the same plan, you could be paying more next year than you are right now. We encourage our clients to shop their Drug Plan each year during the Annual Election Period, October 15th through December 7th.

2. Compare Pharmacies

Many people find that their medications are different prices depending on which pharmacy they use. You should consult with at least two pharmacies in your area to compare prices. You can also check with your Part D provider to see if they have a preferred pharmacy or mail-order option, as they will often have lower rates. Some of our clients choose to use more than one pharmacy, in order to get the best prices on all of their medications.

Bonus Tip: Occasionally the cash price of a prescription may be less than your copay. When comparing prices, ask the pharmacist what the cash price is as well.

3. Buy in Bulk

You may find that your medications are less expensive if you purchase more at once. For instance, rather than only getting a 30 day supply, picking up enough for 90 days may save you money in the long run. In addition, you may be able to split certain pills in half, which may be to your advantage. For this to work, your doctor would prescribe you double your usual dose, and you would physically cut your medication in half to get the correct dose. This does not work for all medications, but you can talk to your doctor to see if this can work for you. You should also check with your pharmacist, to see what your savings will be.

4. Review Your Medications with Your Doctor Regularly

Speaking with your doctor about your medications is just as helpful for your wallet as it is for your health. By regularly reviewing your prescriptions your doctor can confirm that you are only taking what is necessary and remove medications you no longer need. Your doctor also may be able to help you find discounts or lower-cost options if you explain that you are concerned with cost. It is important to keep in mind that while changing your medication to a generic option can save you money, it may impact your health. You should speak with your doctor about any potential risks before deciding if that is the right choice for you.

5. Go Online

There are many resources you can use online to help cut costs. State RX Plans help people find local resources to aid them with their healthcare costs. You can search for programs that help people with specific diseases or medication by searching “Patient Assistance” followed by either the medication or disease name.

Additionally, people who qualify for Extra Help may receive assistance to pay for their prescription drug costs, if eligible. Medicare could pay for 75% or more of your drug costs, including monthly prescription drug premiums, annual deductibles, and coinsurance. For more information about Extra Help, contact your local Social Security office, or call Medicare, 1-800-633-4227. TTY users should call 1-877-486-2048.

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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