A recent Optum Study suggested that some generic prescription prices are going up while most are staying steady.
Finding the “perfect” Part D prescription plan has caused us significant headaches at Doctor’s Choice – it simply does not exist.
There’s no “Cadillac” drug plan and plans can change year after year. This is especially confusing to individuals on supplemental plans where their medical benefits typically stay the same year after year.
However, there are key guidelines to make sure that you’re getting a good deal on your generic prescriptions.
1. Not all generics are in “generic tiers”
Just because a prescription is a generic, it does not mean that it will fall under a lower tier. Sometimes, generic drugs are placed into brand name tiers and therefore command substantially higher co-pays. Make sure to double-check the exact tiers of your medications by using the plan formulary or going on the medicare.gov website.
2. Different Part D plans may have different negotiated prices for the same prescriptions
Aside from different co-pays for generics, many plans have different negotiated prices for the same prescriptions. For example, a 30 day refill of HCTZ may cost Plan 1 $10 versus $5 for Plan 2 (we made those numbers up for illustration purposes).
This is important to those who will fall into the “Donut Hole” or coverage gap. In 2015, the coverage gap starts when the full price of medications reaches $2960. In the coverage gap, individuals will be paying 65% the cost of generics.
Since the full price of generics vary from plan to plan, a generic costing $10 will get you to the coverage gap faster than if the same generic costs $5 with another plan.
3. Drug prices may change throughout the year
Even though your co-pays, deductibles, or co-insurances will generally not change throughout the calendar year, your drug prices may go up or down.
This is especially true in cases where the full price of the drug is less than the co-pay.
For example, if a Tier 3 co-pay is $40 and the full price of your tier 3 prescription only costs $20, then you’re going to most likely pay $20 at the pharmacy and not the full $40. However, if the cost of that drug goes up to $50 during the course of the year, you may find yourself paying that full $40 co-pay.
Some plans offer discounts if you go to certain pharmacy chains. If your retirement affords you more free time, it may be wise to shop around to see if you can save some extra dough on your prescription costs.
Depending on whether you like puzzles, navigating Medicare prescription costs can be fun or a nightmare.
To make sure that you’re getting the best deal, don’t just shop around for the best drug plan but also shop around for the cheapest pharmacy.