Using cost-saving drug plans with Medicare Part D

I had a great experience which helped me from getting in the Medicare “Donut Hole” with an expensive generic prescription for Parkinson’s. When I went to my Plan D preferred pharmacy, I was informed that the specific generic was not in my Part D plan’s formulary and would cost $460 per month. I then went to another pharmacy and was told the retail price was $199 per month.

I discussed my experience with a friend, and she told me about GoodRx.com. What a blessing this was! By entering my zip code, GoodRx gave me a printout of stores that sell the drug at a discounted price with no strings attached. I went to one on the list with the GoodRx coupon in hand. The cost for a one-month drug supply was only $43. How can the price of a generic drug range in price from $43 to $460?!

Something is wrong with America’s prescription drug system. Tell your readers not to give up if they get an outrageous price for a drug. There are several websites like GoodRx providing a similar service. You just have to do your homework!

--Sarah from Tulsa, Okla.

Hi Sarah:

Thank you for sending the Toni Says Medicare team this information on GoodRx. America needs to be aware that you can use “cost saving prescription drug plans” like GoodRx, SingleCare, ScriptRelief, or other discount programs to help control the cost of your Medicare prescription drugs.

By not placing these expensive generic or brand name drugs on your Part D plan, you can prevent getting into the Donut Hole as fast or at all.

Readers, I personally had a generic antibiotic and allergy medication prescribed last week, and when I went to pick them up using my own Medicare Part D plan, both generic prescriptions together were over $120. I remembered Sarah’s email and while sitting in the store’s parking lot, I looked online at GoodRx. The savings was more than $60 with the antibiotic costing $30 and allergy med $28. I gave the pharmacist the GoodRx coupon on my phone and it worked! (Other pharmacies would have saved me more money, but the prescription had already been sent to that pharmacy.)

On its website, GoodRx claims that it is recommended by pharmacists and doctors. Next time, I will go to GoodRx or another prescription discount site and research which pharmacy has the lowest price before I go to get my new prescription. And America needs to do the same to save on their prescriptions.

Readers, Part D costs will be changing for 2024. Here is a summary:

-- Initial Deductible: $545

-- Initial Coverage Limit: $5,030, when the 2024 Donut Hole begins.

-- Donut Hole Out-of-Pocket Costs: You will spend 25% of the brand name drug, the Drug company will spend 70% and the chosen Part D plan will spend 5% until the total spent on your prescriptions is $8000. Then the Donut Hole ends and Catastrophic Coverage begins.

-- New Catastrophic Coverage Medicare Rule: Beginning Jan. 1, when a Medicare recipient enters Catastrophic Coverage, Medicare will pick up all costs of the prescriptions, whether brand name or generic, and those with a Medicare Part D plan pay $0.

On Jan. 1 of every year, the process starts all over again with a new Medicare Prescription Drug plan and different costs, deductibles, and a new Donut Hole.

=========

Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. Toni’s books and her newsletter are available at www.tonisays.com. Toni’s new Confused about Medicare video series is now available for purchase at www.tonisays.com, as are Toni’s Medicare Survival Guide and discounted bundle package.