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How Seniors Can Save on Prescription Drugs

It is no secret that in 2022 inflation is at a record-breaking high. Yet, groceries and gasoline are not the only costs rising in the U.S. With nearly 89% of seniors taking prescription drugs, medications can become a monthly burden for which many are underprepared.

The average monthly Social Security benefit in 2022 is $1,666.29. After necessary expenses, many seniors are left with little to no income to help cover their healthcare costs.

In recent years, the cost of prescription drugs skyrocketed, leaving many unable to afford the care they require. In 2010, total pharmaceutical spending in the United States was $322 billion. Yet, in 2020, pharmaceutical spending rose to $570 billion, an almost 77% increase over a decade.

To help combat these high drug costs, you have options. This unique study analyzes various routes to pay for prescription drugs and provides some price comparisons. We aim to identify the option that allows for the lowest out-of-pocket costs. These include:

  • Enroll in Medicare Part D if you are eligible
  • Utilize discount programs such as GoodRx and Cost Plus Drugs pharmacy
  • Switch to generic medications

In 2021, seniors in the United States spent almost twice out-of-pocket on average for prescription drugs compared to the rest of the world. With a historical inflation rate since then, many people on Medicare will need to budget even more for their prescriptions in retirement.

Below, we share ways you can save on prescription drugs. These include Medicare Part D coverage, switching to generics, and prescription drug discount programs.

How Medicare Part D Plans Can Help You Save

A Medicare Part D plan will pay for a specific portion of your prescriptions. With this coverage, you are responsible for the remaining costs up to the maximum out-of-pocket limit your plan determines.

It is worth noting that by 2025, all Medicare Part D policies will have a $2,000 out-of-pocket cap. However, until then, private insurance companies can set their out-of-pocket maximums.

The number of medications you require can drive your out-of-pocket expenses to increase quickly. So, it is essential to choose the best Medicare Part D plan that includes the prescriptions you need on its formulary, which is the list of drugs the plan covers.

Medicare Part D policies are only available through private insurance companies. These companies abide by Medicare’s regulations, but the carrier can determine (within limits) what is on the drug formularies. Carriers also set monthly premiums and copayment prices. Thus, your meds are of paramount importance when comparing policies.

For example, suppose Linda must take Eliquis. Through one carrier, her annual out-of-pocket costs would be $493.60. But, if she were to enroll in a different Medicare Part D plan through another carrier, she may pay up to $3,926.98. To avoid a costly mistake, Linda should speak with a licensed agent who understands which option would be best for her medications. This example uses two actual Medicare Part D plans in the same ZIP Code.

Like Linda, many seniors are unaware that one simple mistake can lead them to thousands of dollars in unnecessary prescription drug costs. Therefore, it is essential to review your plan options instead of immediately enrolling in the first policy you consider.  

How Medicare Part D Drug Plans Help with Prescription Costs

Medicare Part D carriers set their prices based on their plan’s formulary. A Medicare Part D plan prescription drug formulary is a list of prescription drugs the plan covers. Drug plan formularies change every year. Thus, your out-of-pocket costs may vary annually.

When you enroll in a Medicare Part D plan, there are many advantages compared to having no prescription drug coverage. Benefits to enrolling in a Medicare Part D plan include:

  • Maximum out-of-pocket limit
  • Set drug costs
  • Preferred pharmacies with lower costs
  • Mail order pharmacy availability

It is essential to sign up for a Medicare Part D policy when you first become eligible. Doing so will help you avoid paying the Medicare Part D late enrollment penalty. The Medicare Part D penalty accumulates each month you go without drug coverage and never goes away. This means you must pay the fine as long as you have Medicare Part D.

What are the Limitations to Medicare Part D?

Depending on which prescriptions you require, falling into the Medicare Part D donut hole or meeting your policy’s out-of-pocket maximum early in the year is not exceedingly rare.

For example, you will enter the donut hole if you take high-cost medications and your total prescription drug costs reach $4,660 in 2023 (including what you paid out-of-pocket and what your plan paid). Then, you will stay in this coverage gap until your costs reach $7,400.

Once in the Medicare Part D Donut hole, you must pay 25% of the retail cost for your drug, regardless of how high that cost may be. When you enter the donut hole, your out-of-pocket drug costs could reach an all-time high because you are paying a quarter of the price. 

In this case, discount programs, generic drugs, and low-cost pharmacies can help prevent your costs from significantly rising. However, due to the recent passing of the Inflation Reduction Act, by 2025, this drug phase will be removed, and all Medicare Part D drug spending will come with a $2,000 cap.

How Discount Drug Programs Can Help You Save on Prescription Drugs

Discount drug programs like Cost Plus Drugs pharmacy or GoodRx are available to help relieve consumers of high costs for prescription drugs. These programs provide the same medications you already take at a fraction of the cost.

GoodRx is a coupon program that allows you to go to specific pharmacies with a coupon to receive your prescriptions at a lower cost. This will enable you to lower your drug costs without utilizing your Medicare Part D benefits. GoodRx coupons can often save you money compared to Medicare Part D plans.

Cost Plus Drugs is an online pharmacy that allows you to purchase drugs at the manufacturer’s cost with a 15% markup and additional cost for shipping. Compared to Medicare Part D costs and often GoodRx coupons, Cost Plus Drugs typically offers the lowest prices when filling your prescriptions.

However, you must ensure they carry your medication before relying on the pharmacy. Currently, not all drugs are available through Cost Plus Drugs. However, they offer many popular drugs and are constantly expanding their inventory.

What are the Limitations of Prescription Drug Discount Programs?

Despite the low drug prices, prescription drug discount programs and low-cost pharmacies are not always reliable.

GoodRx discounts are not guaranteed as they are coupons that can go away anytime. Even though GoodRx may cover your drug at a low cost for one month, they may not offer it for the same price the following month.

Additionally, GoodRx may only cover brand-name medications. Thus, there could be a more cost-effective option available through generic medicines.

As for low-cost pharmacies, the prescription drugs you require might not be available through the pharmacy, so it is crucial to continue Medicare prescription drug coverage if these instances occur. For example, Cost Plus Drugs has an ever-growing drug catalog in their pharmacy. However, it does not cover all the medications available in the U.S.

Another drawback of these low-cost options is that when you use Cost Plus Drugs pharmacy or a GoodRx discount, you cannot use your Medicare Part D coverage in conjunction. Therefore, your out-of-pocket costs do not count toward your Medicare Part D plan. You may only use GoodRx or Cost Plus Drugs as a stand-alone discount.

Prescription Discount Programs vs. Medicare Part D

Whether you use Medicare Part D or a discount prescription program, the goal is to obtain medication at a low cost using the most affordable and convenient route. For some, an online pharmacy is ideal. For others who prefer the traditional way, an in-person pharmacy experience using Medicare Part D or a drug coupon may be preferable.

The chart below compares drug costs for the same prescriptions through Medicare Part D, Cost Plus Drugs pharmacy, and GoodRx.

Prescription Drug Monthly Cost Comparison
Drug Name:Medicare Part D*Cost Plus Drugs Pharmacy**GoodRx***
Amlodipine 2.5mg$10.70$8.60$14.13
Clopidogrel 75mg$10.70$10.10$14.15
Imatinib 100mg$189.18$19.40$117.37
Letrozole 2.5mg$16.00$10.70$13.20
Mesalamine 100mg$506.49$37.40$86.28
Tizanidine 2mg$14.72$8.60$10.58
Zonisamide 25mg$15.28$8.90$26.32

*Medicare Part D prices include a monthly premium for the lowest cost plan

**Cost Plus Drugs prices include a $5 shipping fee

***GoodRx prices include a $9.99 monthly GoodRx Gold membership fee

The table above shows a significant cost difference between the three coverage options. While they cover every drug in the example, each program covers them at a different level, leaving you with varying out-of-pocket costs.

However, issues can arise if you rely solely on GoodRx or Cost Plus Drugs, and they do not carry your drug or offer a discount on the medicines you require. Because of this, many seniors will still enroll in a Medicare Part D plan as a backup in case they cannot get their drugs through a more cost-effective route.

Can Generics Help You Save on Out-of-Pocket Drug Costs?

Speaking to your physician about switching to generic prescriptions is another way that many seniors can save money each month on prescription drugs.

Generic medications are the same as their brand-name counterparts without a prominent manufacturer. Every generic prescription drug is FDA-approved and provides the same care, risks, and results as its brand-name counterpart – for a fraction of the cost.

You should speak with your doctor to determine if your medications have generic options or if similar, less expensive drugs may treat your condition(s). Then, you can compare costs between your name-brand medicine and its generic counterpart.

Generic medications must use the same or similar active ingredients and produce the same or similar results. This straightforward switch could greatly benefit your monthly budget if a generic drug is right for you.

Generic prescription drugs can cost nearly 80% less than similar brand-name drugs. By switching to generic medications, Americans can collectively save billions of dollars each year on out-of-pocket costs.

The chart below compares brand-name medication costs on a typical Medicare Part D plan to generic expenses.

Generic vs. Brand Name Drug Comparison
Generic DrugMonthly Copayment Cost Brand-Name DrugMonthly Copayment Cost 
Atorvastatin$1.00Lipitor$197.67
Omeprazole$1.00Prilosec$417.65
Rosuvastatin$1.00Crestor$191.50
Montelukast$1.00Singular$287.79

As you can see, generic drugs typically require very low copayments compared to their brand-name counterparts. For many seniors, using generic prescription medications can help you save money each month while receiving the same treatment recommended by your doctor.

How to Lower Your Prescription Drug Costs on Medicare

By compiling and reviewing drug cost data, we have found the easiest way to reduce your Medicare prescription drug spending is to enroll in the proper Medicare Prescription Drug plan to cover your medications, use generic prescriptions when available, and utilize discount drug pharmacies and programs. We understand that drug costs can be high, but when using the optimal channel, you can significantly reduce your costs.

While no option is one-size-fits-all, it is beneficial to know that low-cost drug options are available. With the help of a licensed Medicare agent, you can ensure you enroll in the right drug plan for your needs and halve your out-of-pocket costs by reviewing your Medicare drug plan each year.

Remember, you can only change your Medicare Part D plan once per year, during the Annual Enrollment Period – unless a particular life circumstance allows you to change plans at another time. Thus, you should be cautious about enrolling in the best drug policy to avoid a costly mistake.

In addition to the above advice for reducing drug costs, many Americans hope to find relief for high drug costs through legislation such as the recently passed Inflation Reduction Act of 2022. This Act places a cap on Medicare Part D out-of-pocket drug costs and helps alleviate millions of Americans’ financial burden of prescription drugs.

Sources

  1. Prescription Drugs and Older Adults, KFF. Accessed October 2022.
    https://www.kff.org/health-reform/issue-brief/data-note-prescription-drugs-and-older-adults/
  2. Prescription Drug Prices in the United States Are 2.56 Times Those in Other Countries, Rand Corp. Accessed October 2022.
    https://www.rand.org/news/press/2021/01/28.html
  3. How to Save On Medications With the GoodRx Gold Drug Savings Program, GoodRX. Accessed October 2022.
    https://www.goodrx.com/corporate/goodrx-gold/save-on-medications-goodrx-gold-drug-savings-program/
  4. Generic Drugs: Questions & Answers, FDA. Accessed October 2022.
    https://www.fda.gov/drugs/frequently-asked-questions-popular-topics/generic-drugs-questions-answers
  5. What Medicare Part D drug plans cover, Medicare. Accessed October 2022.
    https://www.medicare.gov/drug-coverage-part-d/what-medicare-part-d-drug-plans-cover
  6. Medicare Patients Pay More for Drugs Than Older Adults in Other Countries; Congress Has an Opportunity to Move Forward, Commonwealth. Accessed October 2022.
    https://www.commonwealthfund.org/blog/2021/medicare-patients-pay-more-drugs-older-adults-other-countries-congress-has-opportunity
Allison Auvil

Allison Auvil

Content Strategist
Allison Auvil is a Content Strategist at Elite Insurance Partners. With a bachelor’s degree in visual arts, Allison brings a creative perspective to her writing. She has been involved in content writing and editing for the past five years. The combination of an extensive Medicare101 training program and daily thorough research has made Allison a Medicare Guru. A detail-oriented writer, Allison is focused on writing pieces that are accurate, informative, and easy to read. She begins her writing process with meticulous research and note taking. Once her data is compiled, Allison enjoys the challenge of taking complex data and information and creating articles that are easy to understand.
Ashlee Zareczny

Ashlee Zareczny

Compliance Supervisor and Licensed Medicare Agent
Ashlee Zareczny is the Compliance Supervisor for ApplyforMedicare. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.
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