by Marc Manor

The plight of those Medicare beneficiaries that take one or more high-cost prescription drugs can be challenging.  As with anything in the Medicare Advantage or Prescription Drug Plan (PDP) world, it can be difficult to find affordable solutions.  Sometimes, it may be possible to save a few dollars if we take the time to research a few variables.  Prescription drugs are categorized in “tiers” that relate to the coverage level according to the benefit schedule of each PDP and generally, the higher the tier, the more expensive the drugs will be for the consumer (and the plan).  Here are some factors to consider:

Generic vs. Name Brand Drugs

Generic drugs are generally in the lower tiers and are lower in cost on the benefit schedule than name brands.  Ask your doctor if generics will work for you.  If so you can save significant money in most cases. 

Plan Formularies

Each PDP or Medicare Advantage Plan with Prescription Drug Coverage (MAPD) has a drug formulary.  Each drug is assigned to a formulary and a corresponding “tier”.  Different plans have different formularies and what may be a Tier 1 in one plan could be a Tier 2, or event 3 in a different plan.  Find out where your drugs fall in each plan before you enroll.

Coverage Stages

There are four coverage stages in the Medicare Prescription drug world.  They are:

  1. Deductible Stage: Deductibles may be drastically different for each plan.  The deductible may be a significant factor in how your prescription drug dollars are spent.  Make sure you know the deductible before you enroll.
  2. Coverage Stage: This is when the benefit schedule of the plan applies as it is straight away.  The out-of-pocket costs can be easily determined by looking at your plan materials. 
  3. Coverage Gap (Donut Hole):  This is when the amount applied to each drug purchased reaches a certain limit (for 2020 this is $4020).  This includes the full cost of the drug; not just what the consumer pays but what the consumer + the plan pays.  Once the expenditures for drugs reach $6350 in 2020, you have reached the catastrophic coverage stage.
  4. Catastrophic Coverage Stage:  This is when the plan will resume prescription drug coverage, usually at very affordable rates. 

Preferred vs. Standard vs. Mail Order Pharmacies

By in large, mail-order will save you the most money are your prescriptions.  When authorized, you can get a 90 day supply of your drugs and have them delivered.  If your plan designates some retail pharmacies as “preferred” pricing.  Using “preferred” network pharmacies can be another way to save significant dollars for prescriptions.  Pharmacies designated as “standard” may have higher rates so make sure you understand your plan’s benefit schedule as it applies to you.

I highly recommend using an independent agent always but especially if you are prescribed with multiple drugs.  Due diligence on researching which plan meets your needs and save your money could result in “tiers” of joy instead of “tiers” of sadness.

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits.          As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions.        There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.

Marc Manor licensed insurance agent for medicare