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Getting the Best Drug Pricing


Even though we highly encourage you enroll in a Medicare Part D plan for prescription drug coverage, that plan may not always provide the best pricing. Let's take a look at how prescription drug pricing works.


Medication Tier. Each medication falls under a coverage tier, tiers 1-5 with tier 1 being the least expensive. Many plans will waive the deductible and charge the lowest co-pay, often a $0 co-pay for tier 1 medications. The higher the tier, the more you will pay in copays.


Part D coverage phase. Your Medicare Part D plan has 4 different phases of coverage. Deductible, Initial coverage, Coverage gap, and Catastrophic coverage. The price you pay can change throughout the year, depending on which phase you are in. Coverage for Xarelto, for example, could change from $445 in the first month, $100 for the next 3 months, then $125 per month after that.


Pharmacy network. Every Part D plan has a network of “preferred” pharmacies. They have negotiated better pricing at these pharmacies. You should definitely use the preferred pharmacy for your plan to get the best pricing. Again using Xarelto as an example, in network pricing could be as low as $30 per month, out of network as much as $120 while in the same coverage phase.


GoodRX and other discounts. Yes, you can use discounts instead of your Part D plan. But be aware, the amount you pay will not be applied to your deductible. You should calculate how much the medication will cost you for the rest of the year in each coverage phase, not just how much it is for one month.


The Best Pricing. Use a generic medication if you can. Fill your prescriptions at your plan’s preferred pharmacy. Stay aware of what coverage phase you are in. If you have a new prescription, ask your pharmacist to check the price under your plan, and compare that to any discounts or coupons available, like GoodRX.


How to compare plans. Each year, during the Annual Enrollment Period October 5 – December 7, you will be encouraged to compare plans. You can best do this using Medicare.gov online, or calling Medicare directly. When it gets closer to the AEP we will send out step by step instructions on how to do this. In the past, we have done this for our clients as a free service. We can no longer do this as Medicare has made changes to their comparison tool and many insurers no longer pay commissions on these plans. But we will teach you how to do this for yourself.


This is provided for informational purposes only and is not intended to substitute for professional advice. Randy Foulds of Foulds Health Insurance Agency is an independent broker and Medicare specialist in La Quinta. license #0G69218. You can reach him at 760-346-6565.

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