As we approach the end of Medicare Open Enrollment (December 7), it’s still time to check Medicare.gov to be sure you have the right Part D drug plan. The high cost of prescription drugs is ridiculous and untenable, and without any insurance coverage, you can pay thousands of dollars out of pocket. Since different plans do have different costs, you want to be sure you have the right plan for your needs.
Having a Part D drug plan is not mandatory. It’s voluntary if you are covered by Medicare. (Note of caution: If you are enrolled in a Part C Medicare Advantage Plan or have an employer or union plan, you should already have prescription drug coverage, so this does not apply to you.) But if you have Original Medicare plus a Supplement or Gap plan, prescription drug coverage is not included. if you don’t sign up for Part D when you turn 65, there is a financial penalty for every month you wait to get it. You may think you don’t need one because you don’t take any drugs, or at least any expensive ones. But if you end up with diabetes and need insulin, or have a heart problem and need one of the blood thinners, you will wish you had signed up earlier.
Why do we pay so much more for prescription drugs than any other country? The drugs are the same in Canada or Switzerland as they are in U.S.. However, a vial of insulin in Canada may be $20 while it can be $300 in the U.S. Drug manufacturers tell us that U.S. manufacturers bear the cost of the research and innovation that companies in other countries do not have to pay. But it’s much more complicated than that. The U.S. does not regulate prices like other countries do. In fact, the Medicare law currently prohibits that type of negotiation over price. The drug lobby has kept that prohibition in place for many years, but there are signs that Congress may be ready to overturn that prohibition. (And a letter or call to your Congress Person would help speed up that action.)
While you wait for Congress to act to lower drug prices, here are some ways you can keep your own drug costs as low as possible.
- If you are over 65, be sure you have drug coverage. Call the number on your insurance card to be sure. If you have a supplement or gap plan without drug coverage, go to Medicare.gov and enter the drugs you currently use. You can enter the pharmacy you want to use and see the difference among plans offered in your area. Before December 7th, you can change your drug plan easily online.
- Use a GoodRx coupon and use their website to find cheaper options for the drugs you take.
- Ask your doctor about cheaper, generic options. I just found out that the insulin drug Humalog actually has a generic called Insulin Lispro. The difference in cost between the brand and the generic is astounding.
- Use mail order wherever you can. A 90 day supply is usually much cheaper than a 30 day supply or purchase at a retail pharmacy, and the convenience of having the drug mailed to you is really great. If you forget to reorder, most of these mail order plans will remind you, or you can always ask your doctor to call your 30 day supply into a local pharmacy in your network.
- Most drug companies offer financial assistance if you can prove your income meets their conditions. Don’t be afraid to contact them and ask if they can help you out.
These are just some of the ways you can address the high costs of prescription drugs. Check out alternatives. Advocate for prescription drug reform with your Congressional representative. Ask for help anywhere you can get it. Don’t let the ridiculous prices defeat you!
Just a note of caution: Not everyone over 65 years of age should sign up for Medicare Part D. If you have employer or union health and drug coverage and you sign up for Medicare Part D, you and your dependents may be dropped from your health and drug coverage. You should consult your employer or union health coverage benefits advisor before signing up for Medicare Part D.
As an example, my husband and I have Federal Employee Health Benefits Program (FEHBP) BC/BS as well as Tricare for Life. We therefore have drug coverage and should NOT sign up for Medicare Part D as we would jeopardize the coverage we already have.
Sadly, very little about health insurance in the US is simple.
Thanks to Margan for the update on employer and union plans. I edited the post to reflect the fact that people over 65 in those plans should NOT sign up for Part D because they can be dropped from what might be better coverage. This note of caution about having drug coverage applies to people over 65 who have what we call “Original Medicare” plus a Supplement or Gap plan. Those supplemental plans usually do not include drugs, so you have to go to Medicare.gov and find a separate Part D plan.
Confusing? Sadly it is.