Plans
Answers to ALL Your Medicare Questions
Rena
630-233-9900
SEARCH BY TOPIC

Tips For Saving Money On Your Drugs

A doctor client once explained to me how expensive name-brand drugs often get prescribed by doctors. Here is how the process happens: A highly paid pharmaceutical rep comes to the doctor’s office pulling a small suitcase filled with prescription drug samples of that company’s drugs. The rep meets with the doctor and when the rep leaves, like a prospective beau would leave behind flowers or a box of chocolates, our pharmaceutical rep woos the doctor with a big supply of samples. The doctor then takes these samples and puts them in a drawer.

When a patient comes in with a medical problem the doctor opens up the sample drawer and hands the patient some sample pills and says, “Try these.” A couple of weeks later the patient comes back and the doctor asks how it went with the pills. The patient answers, “Great.” So, in knowing the pills helped, the doctor writes the patient a prescription for that drug.

Here is your Business 101 quiz question: Was there a connection between the pharmaceutical company’s Drug Rep leaving the drugs and the doctor prescribing them? If you answered yes, you’re right. If you also concluded that pharmaceutical companies are clever in giving out samples to influence doctors into writing expensive prescriptions, once again you’re right.

The bottom line is that doctors, as my doctor client told me, rarely think about what a particular drug is going to cost their patient. They hand out samples. They work. So, they prescribe.

This is why a lot of us end up taking name-brand drugs as opposed to inexpensive generics. The fact is that the cheap generic alternative drugs do not have handsome and handsomely paid pharmaceutical reps pitching their merits. When you’re a doctor, no pharmaceutical rep ever comes to your office with a suitcase filled with cheap generic samples to give out to patients.

This leads to Tip One . . .

1. Tip One: Find Lower Copay Drug Alternatives 

We discussed earlier how Medicare Advantage or stand-alone Prescription Drug Plan only needs to have a minimum of two drugs in any therapeutic category.

Not just that, but Prescription Drug Plans put drugs into Tiers. For instance, they can make a drug Tier 1, referred to as Preferred Generic, or Tier 2, which is Standard Generic. Your copay is usually less for a Tier 1 drug than it is for a Tier 2 drug. And if you jump to a Tier 3 or 4 drug, that’s a huge copay jump.

Here is another quiz question. Guess what Medicare drug plan carriers choose to be Tier 1 over Tier 2 or make it into their formulary altogether?

A. The drug they think works the best.
B. The one that is the smallest and therefore the easiest for you to swallow.
C. The drug that has the prettiest color so it goes best with your medicine cabinet décor.
D. The one that costs your drug plan carrier the least.

If you answered D then you know how the world of business works, and the major carriers we get plans from also certainly understand business and the best way to make profits.

But it cuts both ways. By getting the cheaper drugs, as long as that drug is just as effective, you save the carrier money and are rewarded with a lower copay because the drug is in a lower tier. Often this is simply a case of researching what Tier a new drug you are being prescribed is in with your plan. You can do so at my platform:  www.65medi.com 

When you are on the site click the “Add Medications” button and then enter the drug name. Once you type in the first three letters you will get a list of matches then click the right one.

  



Once your drug is entered, find your plan name, and then in your plans listing, click “Details:”


And, then:

You will see your drug tier along with how much your copay is going to be.

 

So what do you now do with this information? Perhaps nothing. But let’s say that Tamsulosin was a Tier 3 drug instead of Tier 2 and your copay went up from $3 a month to $45. Now it might be worth your while to ask your doctor if there is a Tier 2 alternative you could be prescribed instead.

2. Tip Two: Is There A Lower Cost Generic? 

Here is a fun fact. The drug listed in the prior example, Tamsulosin, is a generic version of a drug called Flomax. Tamsulosin will cost you $3 a prescription or $36 for an entire year. But let’s say you want the original instead. Maybe you prefer the color. Here is your estimated cost now.

$303 a month instead of $3 is like the difference in price between a Rolex watch and a Casio. And guess what, they both tell time. Maybe some people buy the Rolex for the prestige but would anyone want to pay an extra $300 a month to brag to their friends that they take Flomax and not Tamsulosin?

When you are on the www.65medi.com website it will often give you the choice of subsiding a generic version of your drug if one is available. But when one doesn’t show up it is still a very good idea to do your homework by asking your pharmacist or doctor or going onto the internet and Googling yourself to see if there is a generic version that could save you big bucks. Or, even, to research if there’s a less expensive drug that is somewhat similar you can ask your doctor about.

Here’s another interesting off-topic fact. Google wasn’t always called Google. When the site was first introduced in 1996 it was named BackRub. Had they kept the name today we’d all be suggesting, “Why don’t you go BackRub it?”

Now, if you’re ever on a game show and the question for a million dollars is, “What was Google’s original name?” Because of me, you will know. “You’re welcome.”

3. Tip Three: Use Preferred Pharmacies 

Below is a typical chart you might see which outlines how much your copay is for the various tiers:




You likely took notice of a big jump in copays between “Preferred Retail” and “Standard Retail”. A Preferred Retail refers to a pharmacy chain such as CVS, Walgreens, Walmart, Costco, or even your local grocery store that also has a pharmacy. Most Medicare Advantage or stand- alone Prescription Drug plans have tens of thousands of members, including you, who fill millions of prescriptions each year. If you think that kind of customer volume is valuable to a pharmacy chain it is. If you think it also gives Drug Plans enormous bargaining power on the overall cost it does.

Each plan uses its negotiation power to strike deals with a different group of pharmacies. Plans designate the pharmacies where they negotiate their best price as being Preferred. Many plans have multiple preferred pharmacies but not all pharmacy chains will be in their preferred category.

With this explanation in hand, you need to know which pharmacies are preferred and which ones are not, called Standard Pharmacies, with your plan. For instance, if CVS is preferred with your plan a Tier 2 drug in the prior example will have a $4.00 copay which is reasonable. If, however, CVS is Standard not preferred your copay catapults to $20.00 in the prior example not so reasonable.

4. Tip Four: Use GoodRx.com To Save Money 

 

President Harry Truman famously said, “There is no such thing as a free lunch.” He was referring to the notion that everything we supposedly get for free actually costs us something. Of course, Harry Truman said what he said at a time when there was no television FREE, or internet also FREE.

GoodRx.com, like many other internet sites, is completely free and earns it’s keep through advertising. All you need to do, if you haven’t used this website (or one of its several competitors), is to go to www.GoodRx.com and enter a drug name. It will then show you all of the pharmacies in your area and offer you a coupon to print that will give you a discounted price for that drug. These discounts can often be 80% or even over 90% off of the price you would normally pay.

If you don’t mind shopping around and getting different prescriptions at different pharmacies you’ll often find one of your drugs listed for $20 at CVS and $10 at Walmart and then with another drug you’ll find CVS has the better deal. Some people will use GoodRx to go pharmacy hoping to get one drug at Costco, another at Walgreens, a third at Walmart, a fourth at CVS. And, think of all the new friends you could make standing in so many pharmacy lines.

Why do pharmacies sometimes offer 90% discounts on a drug? CVS and Walgreens recognize there are two types of people in this world: Those who pay retail and those who always want a deal. Given how little most drugs actually cost the pharmacy, it is better for a pharmacy to make a little profit off of your prescription business than nothing at all. Call it the “Law of Competition”. GoodRx plays one pharmacy against the other to offer the best prices to attract you to their store.

If you are taking just Tier 1 and Tier 2 drugs and using a preferred pharmacy you may well not gain anything by using a GoodRx coupon. But here is something I often encounter especially with Tier 3 and Tier 4 drugs: A Tier 3 drug usually has a copay of around $45 and a Tier 4 around $100. Sometimes a Tier 3 drug such as Xarelto costs $500 which would make a $45 copay from you a pretty good deal and you ought to say, “Thank you drug plan.”

But more times than not Tier 3 and Tier 4 drugs can be bought for $10 to $25 with a free GoodRx coupon, well below your copay amount of $45 to $100. Plus, your plan may have an annual deductible of up to $455 before your plan even contributes anything at all.

When this is the case it is important to know you are not obligated to use your drug plan to purchase a prescription. You can, instead, buy it out-of-pocket taking advantage of the savings from your GoodRx coupon.

5. Tip Five: For Savings and Convenience: Consider Using Mail Order.  

We all love going to the pharmacy, right. We get to enjoy driving our car and testing our skill at parking. Of course, standing in line for our prescription gives us an opportunity to check out the backs of people in front of us. Who doesn’t enjoy that? And, if we have to wait 30 minutes because our prescription isn’t ready then we can wander the store aisles and see what’s new in hemorrhoid medications or enjoy a laugh or two in the greeting card section.

In case you actually don’t like going to the pharmacy, all drug plans give you the option of getting a 90-day supply of your prescription sent to you by mail order. Using mail-order will not only be at the lowest copay cost available for your drug, but it will save you gas costs and BONUS: Give you back something else of value: your time.

Plan G Quote Request