Can I lower the cost of my prescription medications?

Ask Lance



Lance P. Jarvis, SHINEDear Lance,

I simply cannot afford the medications that my doctors prescribe even though I have a Part D prescription drug plan. I am tempted to cut pills in half or take them every other day to make the prescription last longer like some of my friends do. I know that doing this endangers my health, but at this time I can see no other choice.

My question is a simple one: what, if anything, can I do to lower the costs of my prescription medications?

Joan in Clearwater

Dear Joan,

Prescription drug costs have become an increasing financial burden for many Medicare beneficiaries. This is true whether they have prescription coverage through a Medicare Advantage Plan or a separate Part D Prescription Drug Plan.

Let me share with you some actions you can take to minimize the costs of your medications.

• Your first step should be to discuss your financial situation with your doctor(s) just as you have described it to me. There might be a less-expensive branded medication or a generic that they can prescribe for you. Most physicians would rather try to find a less-expensive alternative than have you jeopardize your health by cutting your pills in half to save money.

• Doctors may not know what medications are covered under each prescription plan or what the copayments will be. Each year, you receive a booklet from your plan that contains its drug formulary. Always bring your drug plan’s formulary with you to doctor visits. The formulary lists the medications that are covered under your plan as well as the copayment amount. Show this to your doctors so they can try to find the lowest-cost medication that meets your need and avoid prescribing medications that are not covered by your plan.

• Use pharmacies that are in your plan’s network. These are normally shown in your booklet that contains the plan’s formulary. You’ll usually have the lowest copayments if you do this. If your plan has Preferred Network Pharmacies, you also might save money by using them. Using the plan’s mail-order pharmacy service might be advantageous by reducing or eliminating drug copayments.

• A federal program called Extra Help assists with prescription drug costs, deductibles and drug-plan premiums. If your total monthly income is less than $1,508 ($2,030 for couples) and your financial resources are less than $13,830 ($27,600 for couples), you might be eligible for this program. To apply for Extra Help, you can obtain an application from your nearest Social Security office or apply online at ssa.gov. Many SHINE offices also have the paper application that they can give you.

• Many drug manufacturers have Patient Assistance Programs for their branded medications. Although these programs are primarily intended for people without insurance, some will consider applications from those who have Part D prescription drug coverage either through a Medicare Advantage Plan or a separate Part D Prescription Drug Plan. If you qualify, you may be able to get their medication at no cost. A SHINE counselor can assist you by searching for Patient Assistance Programs that cover your expensive medications. You also might go to needymeds.org to do your own search.

• Each Prescription Drug Plan covers different medications and the copayments for the same medication can vary substantially by plan each year. Medicare’s Annual Open Enrollment Period is from Oct. 15 through Dec. 7. I strongly encourage you to contact a SHINE counselor during this period so they can do a search using your medications to determine which plan will have the lowest total annual costs for you in the coming year. I encourage everyone to do this annually because plans change and prescription medications may have changed. SL

About SHINE

SHINE is an award-winning statewide volunteer program that provides free, unbiased and confidential counseling and information for people on Medicare, their families and caregivers. SHINE is a program of the Florida Department of Elder Affairs and is administered in partnership with the state’s 11 Aging and Disability Resource Centers (ADRCs). In Brevard County, our ADRC is the Senior Resource Alliance, located in Orlando.

To contact a SHINE volunteer counselor for confidential and unbiased assistance, call the Elder Helpline toll-free at 1-800-963-5337 or call 321-752-8080 locally. SHINE has counseling locations throughout Brevard County. Counselors can assist you by telephone or in person. To find a SHINE counseling site near you, go to floridaSHINE.org or call the telephone numbers listed above.