Many American seniors are spending most of their retirement and Social Security benefits on the high costs of medication copays and coinsurances. In this article, I will be sharing some tips that should provide some relief for Part D copays and coinsurances. I will also be going over the positive impact that the Inflation Reduction Act will have on prescription costs for those on Medicare.
Compare prices at different pharmacies. Prices for the same medication can vary greatly between pharmacies, so it’s worth shopping around.
Change your Medicare Part D plan. Changing your plan can help lower the cost of medication. However, it may require you to pay a higher monthly premium.
Look into Medicare Extra Help. This program provides financial assistance for those with limited income and resources to help pay for prescription drugs.
Ask about generic alternatives. Generic medications can be significantly cheaper than brand-name drugs and work just as well.
Check for drug manufacturer discounts. Many pharmaceutical companies offer assistance programs for people who can’t afford their medications.
Consider using mail-order pharmacies. They often have lower prices than retail pharmacies.
Look into Medicare savings programs. These programs can help lower the cost of Medicare premiums, deductibles, and coinsurance.
Ask your doctor if there are any samples of the medication available. Some drug companies provide free samples to patients who cannot afford to purchase the medication.
Please note: You should always check with your pharmacist and/or doctor to see which options are available to you, and whether you qualify for any assistance programs. You can also reach out to one of our Medicare specialists.
There are many pharmaceutical patient assistance programs available in the United States, and the specific programs that are available to you will depend on the medications you are taking and your income level. Here is a list of some programs that may be able to help:
Partnership for Prescription Assistance (PPA): This program helps connect patients with public and private assistance programs to help them afford their medications. https://www.pparx.org/
NeedyMeds: This website provides information about financial assistance programs for prescription drugs, including patient assistance programs and discounts. https://www.needymeds.org/
RxAssist: This website provides information on patient assistance programs offered by pharmaceutical companies. https://www.rxassist.org/
Together Rx Access: This program offers prescription drug savings to eligible individuals and families. https://www.togetherrxaccess.com/
Medicare Part D Low-Income Subsidy (LIS): This program helps with the cost of prescription drugs for people with limited income and resources who have Medicare Part D. https://www.medicare.gov/drug-coverage-part-d/low-income-subsidy-lis
Patient Advocate Foundation Co-Pay Relief Program: This program provides financial assistance to insured patients, including those with Medicare, who need help paying for their co-pays, premiums, and deductibles. https://www.patientadvocate.org/
The Patient Access Network Foundation: This organization offers co-pay assistance for individuals with chronic or life-threatening diseases. https://www.panfoundation.org/
The HealthWell Foundation: This organization offers financial assistance to eligible individuals to help cover the cost of their insurance premiums, co-pays, and deductibles. https://www.healthwellfoundation.org/
It is important to note that these programs have different eligibilities and requirements, and availability may vary by state. Some programs may also be focused on specific diseases or conditions. It is recommended to check with the program websites to see if you qualify and what documentation is needed.
The Inflation Reduction Act of 2022 was signed into law by President Biden on August 16, 2022. The new law includes several provisions to lower prescription drug costs for people with Medicare.
Prior to the Inflation Reduction Act, the Secretary of Health and Human Services (HHS) was bound by a noninterference clause preventing the negotiation of prices for prescriptions for those under Medicare Part D. The recent law amends the noninterference clause to allow for the Secretary of HHS to negotiate the prices for a certain number of the 50 drugs with the highest total Part D spending and 50 drugs with the highest total Part B spending.
The effective year for this provision is 2026 for Part D prescriptions and 2027 for Part B medications. The number of drugs to be negotiated will start at 10 Part D drugs in 2026, another 15 Part D drugs for 2027, another 15 Part D and Part B drugs for 2028, and another 20 Part D and Part B drugs for 2029 and later years. The number of price negotiated drugs will gradually increase over time.
*note – Some drugs will be excluded from the negotiation process.
It is not a secret that some Medicare beneficiaries are paying well over $3,000 in out-of-pocket copays and coinsurances under the current Part D structure. The new law will be implementing a maximum out-of-pocket for Part D and making cost sharing changes to beneficiaries, Part D plans, Medicare, and Drug manufacturers.
Under the current system, Part D benefits are divided into 4 stages: Deductible, Initial Coverage, Coverage Gap (aka Donut Hole), and Catastrophic Coverage. In the deductible stage, the beneficiary is responsible for 100% of the cost. Once that has been satisfied, the cost share for the beneficiary goes down to 25% and the Part D plan is responsible for the remaining 75%. During the coverage gap, the beneficiary is still responsible for 25%, the Part D plan is responsible for 5% of brand name or 75% of generic, and the drug manufacture provide a 70% price discount on brand name drugs. The cost share is significantly different in the final stage, the catastrophic coverage. The beneficiary will pay 5% or a low copay, the Part D plan will cover 15%, and the remaining 80% will be paid by Medicare.
The provision will first implement a $3,250 cap on out-of-pocket costs in 2024 to be reduced to $2,000 in 2025. The only cost share difference in 2024 is the beneficiary will no longer be responsible for the 5% in the catastrophic coverage stage. On the other hand, the stages will be reduced to 3 stages: Deductible, Initial Coverage, and Catastrophic Coverage. The beneficiary will be responsible for 100% of prescription costs in the deductible stage. During the initial coverage, the beneficiary has a 25% cost share, the Part D plan pays 65%, and drug manufacturers must provide a 10% discount. In the catastrophic coverage, the beneficiary will no longer be responsible to pay any cost share for the remainder of the year. The Part D plan will continue to pay at a 60% cost share, the drug manufacturers will provide a 20% discount, and Medicare will cover 20%.
It is likely that this provision will save on prescription costs for many Medicare beneficiaries.
Under the previous structure, most insulin prescriptions were found at a tier 3 with an average copay of $47 per month during the initial coverage stage and increases to a 25% coinsurance in the coverage gap. The new law will put a cap on insulin copays at $35 and the copays WILL NOT change no matter the prescription drug stage.
Medicare generally covers vaccines under either Part D or Part B. Starting in 2023, this provision will require that adult vaccines covered under Part D like the shingles vaccine will have a $0 copay. Vaccines covered under Part B will be unaffected by this provision.
Starting in 2024, the law eliminates the partial low income subsidies level. Therefore, anyone whose income is below 150% of the federal poverty level and under the resource limit will qualify for full low income subsidy.
Since the drug rebate rule had not started, we will see no affect to the current established Medicare prescription coverage.
We do not offer ever plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get more information on all of your options .