7 easy ways to help pay less for your prescriptions
By Sari Harrar
Medications can make up a big chunk of your health care expenses, but these strategies can help you save money. It all begins with understanding your options.
Twenty-seven. That’s the number of prescriptions the average older adult fills each year, according to a 2020 report from the consumer data group Statista. And with the price of many common and specialty prescription medications continuing to rise, per Statista, it’s safe to say that the sticker shock is real.
High medication costs cause up to 40% of older adults to skip needed drugs, skimp on doses, not fill prescriptions or abandon a drug they don’t think they can afford at the pharmacy checkout counter, finds a 2019 report in the Journal of the American Geriatrics Association.
Not taking medications as prescribed by your health care provider, though, can lead to worsening health problems, more trips to the hospital and, ultimately, to higher health care costs, according to the Centers for Disease Control and Prevention (CDC).
The good news: There’s plenty you can do to help lower your prescription costs. These seven strategies are a great place to start.
Cost-saver #1: Use medications covered by your health plan
Most of the time, you’ll pay the full retail price for medications that aren’t covered by your health plan, instead of the lower copay, coinsurance or discounted cost of medications included in your plan’s Drug List (also called a formulary).
That’s because Medicare drug plans negotiate lower prices for the medications on their drug lists, according to the Centers for Medicare & Medicaid Services (CMS). Find out if your medicine is covered by checking the drug list on your plan website. If not, there’s usually a comparable medication with equal effectiveness.
Don’t assume that your health care provider will be familiar with your plan’s Drug List. You can bring a copy to your annual wellness visit, and talk with your doctor about switching to covered medications.
Cost-saver #2: Ask about generics
Switching from a brand name to a comparable generic drug is a smart move that could save you hundreds or even thousands of dollars per year, according to CMS. Generics deliver the same active ingredients found in brand-name versions of the drug; manufacturers have to demonstrate that they work the same way, too. According to the U.S. Food and Drug Administration, generics are equivalent to the brand-name version of a drug when it comes to dosages, safety, strength, quality and effectiveness.
For even more savings, ask your doctor about Tier 1 preferred generics, which generally have the lowest copays. If there’s no generic version of your brand-name drug, your doctor may be able to recommend another generic that treats the same medical condition.
Cost-saver #3: Choose a network pharmacy
You’re most likely to receive the most affordable copays, coinsurance and discounts — when you show your health insurance card at one of your plan’s in-network pharmacies. These pharmacies have agreements with your plan to charge less for medications. Use the pharmacy locator on your plan’s website or call the Customer Service number on your member ID card to find a network pharmacy that’s convenient for you.
Cost-saver #4: Stock up
For many health plans, your copay may be lower when you sign up to receive a 3-month supply of your maintenance medications through a home delivery pharmacy. You may be able to save on brand-name drugs, too. Or get a 3-month supply at a network pharmacy. Depending on your plan and the covered drug, you may also be able to save when you fill a 3-month supply at a retail pharmacy.
Cost-saver #5: Do a medicine makeover
At least once a year, put all of your prescription medications into a bag or tote and bring them to an appointment with your health care provider for a “brown bag” review. Include any vitamins, herbals, dietary supplements and over-the-counter remedies you take, too.
At this medication checkup, discuss potential interactions and side effects, dosages, whether there are any drugs you can stop taking, the best way to take your drugs (time of day, with or without food) and whether there are money-saving alternatives.
Cost-saver #6: Put your pharmacist to work for you
If you get to the checkout counter and are surprised by the price tag, don’t walk away without the medication you need. Instead, ask to speak with the pharmacist about whether there are alternatives, such as generics or another medication, that are a better fit for your budget.
Cost-saver #7: Look into other programs
If medications still strain your budget, there are programs that may help. Assistance from federal and state governments and from pharmaceutical companies includes:
Medicare Extra Help Program. Also known as the Part D Low Income Subsidy, this program reduces out-of-pocket prescription drug costs for eligible Medicare beneficiaries with limited income and assets. Find out more at www.ssa.gov/prescriptionhelp.
State Pharmaceutical Assistance Programs (SPAPs). Available in 17 states and the U.S. Virgin Islands, SPAPs provide help with medication expenses for residents who qualify. Programs vary; some are exclusively for people with disabilities or specific health conditions such as end-stage renal disease. Find out more at www.medicare.gov/pharmaceutical-assistance-program/#state-programs.
Pharmaceutical Assistance Programs (PAPs). Run by drug makers, PAPs include programs for people with Medicare Part D prescription drug benefits. You can check if there’s a program for a medication you take at www.medicare.gov/pharmaceutical-assistance-program.