Drug Coupons Don’t Work with Medicare Part D Plans: Here’s Why
Savvy Medicare beneficiaries are always looking for ways to save on out-of-pocket costs, and drug coupons sound like a great option. However, drug coupons won’t actually work with Medicare Part D plans.
In today’s article, we’ll explain why along with other potential ways you can save on your prescription drug costs.
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Part D and Drug Coupons
To cut to the chase, you cannot use any drug coupons in conjunction with a Medicare Part D drug plan. That includes coupons or discounts from the prescription drug manufacturer, any savings cards you find or get from a doctor, and even sites like GoodRx.
The Anti-Kickback Statute (AKS) makes it a crime to “receive any remuneration directly or indirectly to induce or reward patient referrals or the generation of business involving any item or service reimbursable by the Federal health care program” (CMS).
That’s a mouthful, but in our case, it simply means you cannot use drug coupons with your Part D plan.
Drug Coupons or Part D?
Just because you can’t use a drug coupon alongside your Part D plan doesn’t mean you should avoid drug coupons altogether.
Ask your pharmacist if your drug coupon, the price on GoodRx, or your Part D plan has the best price. In some situations, you may find that a coupon or the listed price on GoodRx is less expensive than your Part D plan.
Here are a few things to consider when it comes to using a drug coupon instead of your Part D plan.
1. Uncovered or Expensive Drugs
Drug coupons can be especially helpful if a new prescription is not covered by your existing Part D plan or if the drug is in a higher tier, and thus has higher copays at the pharmacy.
Part D plans can even make changes to their formulary, or list of covered drugs, throughout the year. In these rare cases, you could have a big price jump on a medication you’ve been filling for months.
In any case, if you have a drug coupon or are intrigued by the price on GoodRx, it doesn’t hurt to ask your pharmacist what your costs are in each option.
2. Part D Deductible
One downside of using a drug coupon instead of your Part D plan is your purchase won’t count toward your Part D deductible.
If your deductible is $400 and you fill a prescription for a $25 copay, you will have $375 to go until you reach your deductible. Once you reach the deductible, your plan starts paying their share of prescription drug costs.
If you use a drug coupon and fill that same prescription for $15, your deductible will still be $400. It’s up to you to decide if the savings make sense instead of working your way toward your Part D deductible.
3. Pharmacists Can’t Tell You the Lowest-Cost Option
Unfortunately, most pharmacists can’t tell you if there’s a lower-cost option for a prescription you’re filling.
There is something called a pharmacy gag rule, which means a pharmacist is not allowed to tell you if there’s a cheaper way to fill your prescription.
Many states are trying to end pharmacy gag rules, but in the meantime, it’s up to you to start asking questions about your prescription costs.
Drug Coupon Alternatives for Part D Drugs
While you can’t use drug coupons in conjunction with your Part D prescription drug plan, there are a couple of ways to save on prescriptions.
1. Take Generics
First, make sure the prescription you’re taking is a generic, if available.
2. Lower-Cost Generics
If it is, and it’s still expensive, ask your doctor if there are any lower-cost alternatives. Some generics are much more affordable than others, and they may treat the same exact symptom or condition.
3. Ask for Samples
Also, consider asking your physician for samples. You may be surprised at what your doctor or specialist has in that sample closet!
4. Run a New Drug Plan Comparison
Finally, during the Medicare Annual Enrollment Period, which lasts from October 15-December, let us run a new drug plan comparison. We will input your exact medications and pharmacy, and the most competitive plan will rise to the top.
New plans come out every year, and the competition is heating up. There may be a new plan that can save you hundreds of dollars.
You may not be able to use drug coupons alongside your Part D plan, but there are ways to save on your prescription costs.
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