Since most prescription drug plans change every year and new plans are effective on January 1, it is important to understand the best ways to minimize your costs with your prescription drug plan. Here are a few tips:
Use a preferred pharmacy
Prescription drug plans offer preferred pharmacies, standard pharmacies and mail order pharmicies. Your cost share is lower when you use a preferred pharmacy. A preferred pharmacy with one plan could be out-of-network with another plan. It is important for you to know the preferred and standard pharmacies for your current prescription drug plan.
A standard pharmacy will have a higher cost share but you will still be able to purchase medications at a lower cost than if you didn’t have a prescription drug plan.
If you use a pharmacy that is out-of-network, you will most likely pay full price for the medications and will probably experience a little sticker shock! Pay attention to the preferred and standard pharmacies so that you can take advantage of the lower co-pays offered on your prescription drug plan.
Every year, insurance companies negotiate pricing with different pharmacies and what was a preferred pharmacy last year might not be a preferred pharmacy this year.
Know Your Drug Tiers
Each plan has a formulary, also known as a drug list. Tiers range from a 1 to 6, depending on the plan. Tier 1 and Tier 2 medications are generally considered generic and have a lower co-pay.
Newer medications and brand medications are often a Tier 3 or higher and have a higher cost share. If your doctor prescribes a new medication, check your prescription drug formulary. Then be sure to check the tier of that medication. If the medication is not on your formulary, check to see if there is an alternative that your doctor could prescribe.
There are many prescription drug plans available. Each plan has a different formulary making it difficult for your doctor to know what medications are covered on your plan. Help your doctor help you by bringing your formulary with you to your doctor appointments. This could help you to keep your prescription drug costs managable.
Deductible
In 2022, the maximum deductible is $480.00. There are some plans that have a lower deductible or no deductible. Plans with a lower deductible usually have a higher monthly premium.
On some plans, the deductible only applies to certain tier medications, so understand your plan and when the deductible will apply
Discount Coupons
Discount coupon programs offer help with medications, particularly those not covered on your prescription drug formulary. A few things to keep in mind with these discount coupon programs:
- They are not a replacement for prescription drug insurance. They are just there to help if something isn’t on your formulary.
- Some medications might be less expensive with a discount coupon. Evaluate the impact on your deductible, co-pay and coverage gap.
- Use this option carefully for medications covered by your prescription drug plan.
- Remind the cashier that you are using a discount coupon. This minimizes it being processed through your prescription drug plan.
- There are many different programs available today and we recommend you check 2-3 for each medication that is not on your formulary so that you can receive the best discount pricing.
Where To Get Prescription Drug Discount Coupons
There are several online platforms that offer discount coupons for medications. More appear to pop up every month.
In addition to the platforms listed below, many manufacturers offer discount coupons. These are generally for newer, more expensive medications. Not all are available for those on medicare prescription drug plans. Talk with your doctor and review the manufacturer websites for specific information on your medication. Some also offer coupons for those with financial need.
Online Disount Coupon Platforms
Click on each link below and download the application on your phone. Be sure to also bookmark them on your computer for easy access.
CleverRX – we’ve been using this one for awhile. They should definitely be one of your go to resources
GoodRx has been around for awhile and is currently doing some heavy advertising.
Needymeds.org is a non-profit organization. It is recommended by many health insurance agents. Lynn Michel has not used this service so please investigate thoroughly. The website has good information and offers a discount card
It is very important to evaluate the deductible, co-pay and potential coverage gap factors before using a discount coupon. Discount coupons should not replace your prescription drug plan.
Canadian Pharmacies
Another option for purchasing expensive medications is through canadian pharmacies. We do not have any first hand experience with them, therefore, we encourage you to evaluate them carefully if you choose to use them.
If you have any questions about your prescription drug plan or any other insurance coverages, please do not hesitate to contact us.