Prescriptions can be the most costly part of Medicare . One of my clients has a medication for rheumatoid arthritis that costs $22,000 for a once per month injection medication. Many of my clients have expensive medications. Asthma inhalers and insulin injections are notorious for extremely high costs. How can we circumvent these high costs? In this article, I will discuss the various ways I have helped clients save on the high costs of medications.

Just in the past 20 years, there has been a huge increase in Rx spending.

How to Save on Rx Costs

  • Ask your doctor about alternative medications
  • Request a formulary exception
  • Shop prescription discounts
  • Look into government and non-profit programs
  • Investigate pharmaceutical company programs
  • Find out if a medication can be administered in the doctor’s office
Colorful Capsules
Medicare prescription plans are required to cover at least two medications for each medical issue.

Ask for Alternate Medications

Next time you visit the doctor, ask her if there are alternatives to that high cost medication that can be used to treat your condition. Generally, the doctor will not share this information unless asked directly. You might also ask why she prefers one medication over the other. There may be generic or lower cost options available that can save you significant out of pocket costs.

Request a Formulary Exception

Most Medicare prescription plans have 5 tiers. Each medication is assigned a tier level, which determines how much that prescription will cost.

One of my clients had to get a biopsy for a growth on his skin. For two weeks prior to the biopsy, he had to stop taking his blood thinner medication and use a once-a-day injection instead. He called me and asked what he could do because the cost of each daily injection was $100. He could not afford $1400 just to change out his medication for two weeks.

I told him about the possibility of asking for a “Formulary Exception” in which a prescription plan can lower the tier level as an exception, thus saving the patient money.

He called his plan and explained the situation. They granted his exception and told him that the total cost for the 14 days of injections would be $240 instead of $1400. It never hurts to ask!

Shop Prescription Discounts

One of my favorite prescription discount websites is Goodrx.com. There are a variety of other websites that do the same thing–just enter “prescription discounts” in your search engine for a list.

Shopping in one of these discount platforms can not only show you how to get your medications at a lower cost, but also help you find which pharmacy to go in your area for the lowest costs. It is amazing the difference in prescription cost from one pharmacy to the next.

There is help for the high cost of medications!

Extra Help and Other Programs

For some of my clients, the cost of medications can cause financial strain to the point of having to cut something essential in order to afford medications. There are programs that can help with medication costs depending on the individual’s income.

There is a program within Medicare, called Extra Help, which will cover the costs of medications and sometimes even the premiums for the prescription plans depending on the person’s income level.

There is another program, called Prescription Hope, which can provide higher cost medications for a monthly cost of $50. This program is also for low income individuals, but may help those who do not qualify for Extra Help.

Investigate Programs Offered by Pharmaceutical Companies

Pharmaceutical companies often offer savings programs for patients.

How can you find out if the pharmaceutical company offers any help for high cost medications? Needy Meds! Just enter your medication in the upper left side of the home page and you will see the options.

This is a list of ways Needy Meds can help with Rx costs.

If there is an option for “Coupons, Rebates & More”, you can get a coupon to use at the pharmacy. You can use this coupon instead of your plan in the event that you “fall into the donut hole” and your Rx prices jump up. The coupons are not contingent on having a low income. The Patient Assistance Programs are frequently offered to lower income patients.

Find Out if Your Medication Can Be Administered in the Doctor’s Office

In the beginning of this article, I mentioned a client who takes a monthly injection medication that costs $22,000. She went to her doctor to ask if she can come in each month to receive the medication.

This doctor agreed and helped her by ordering the medication into his office. Now, all she has to pay is an office visit copay.

When medications are administered in a doctor’s office, the cost falls under outpatient care (Part B of Medicare) rather than Part D, Prescription Drug Plan.

A few of my clients have told me that they purchase their prescriptions abroad. I have a couple who travels to Italy to see family every year and they buy a year’s supply of their meds for a fraction of the cost while they are away. Another lady I work with was purchasing her asthma inhalers from an online Canadian pharmacy. This is an option that I am not as familiar with, however the people who do this claim that they have saved a lot on their medications.

Even though there are so many ways to save on medications, there are still times when we cannot escape the high cost of medications. The pharmaceutical industry is huge and the trend is that it will only increase. We all need to be proactive to stay ahead of curve.

 

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