Ask The Advisor: September/October 2017

Ask The Advisor: September/October 2017

Q:  I take 7 prescription drugs every month including one very expensive brand name drug. I just received a notice that my drug plan will be increasing the co-insurance for that drug in 2018, and the premium is going up about 10%. I enrolled in this drug plan when I first became eligible for Medicare 6 years ago. What can I do to manage these costs?


A:  Whether you are enrolled in Medicare with a separate prescription drug plan, or a Medicare Advantage plan that includes prescription drug coverage, it’s important to make sure you are enrolled in the best plan for your needs. It can make a difference between whether you can afford your medications or not.

In 2016, Consumer Reports Best Buy Drugs conducted a small check on prices for generic medications using the Medicare Plan Finder. They found big differences among 19 drug plans. Based on the drugs they checked, annual costs varied from $400 in some plans to more than $1,700 in others for the same drugs. Brand name drugs could vary significantly. For example, Lantus insulin ranged from $25.35 after meeting the deductible, to $286.79 depending on the plan.  You pay the most when your drug isn’t covered by your drug plan. Then you have to come up with the full cost of the drug.

TSCL strongly recommends that you review your drug coverage and compare plans to find out if you can find better coverage and lower co-pays — a good thing to do each year. You can make changes during the Medicare Fall Open Enrollment period that starts October 15th and ends December 7th every year. Here are some steps to take:

  • Review your plan’s Annual Notices Of Changes. This should have been mailed to you in September. Take a look at the page(s) that shows what costs will change, including premiums, co-pays and co-insurance.
  • Look up the drugs you take. Learn if there have been any formulary changes. For example, drug plans have been placing more expensive generics and brand name drugs on higher “non-preferred” tiers. Compare the tiers for 2018 and co-pays with what you pay now. If you don’t see a drug listed you might need to call your drug plan.
  • Check your pharmacy choices. Getting a 90-day supply of your maintenance prescriptions filled by mail from your drug plan’s preferred mail order pharmacy can often be a huge money saver. Compare the costs for using mail order versus monthly visits to a retail pharmacy.
  • Use the Medicare website’s “Drug Finder” tool at Medicare.Gov to compare drug plans. The tool will need your Medicare number, the county where you live and a complete list of the prescriptions you take, as well as dosages. Take care to enter the prescription names correctly!
  • Look for lowest total costs, not just premiums alone. Even when you see a deductible listed, don’t be put off. Check your lower costing plans. For example, some plans may allow you to get your preferred generics “before the deductible”, meaning the deductible only applies to higher tier drugs. In like manner, a zero deductible may not be your best deal if you still have higher costs due to expensive premiums and higher co-pays.
  • Check the plan’s preferred pharmacy. Plans negotiate lower rates with “preferred pharmacies” and some pharmacies may not participate in some plans at all. If the pharmacy doesn’t accept your coverage then you would pay significantly higher costs.
  • Get unbiased help. Before making the decision to switch plans it’s a good idea to get unbiased counseling about your choices. Call or visit the website of your State Health Insurance Assistance Program (SHIP). Your SHIP counselor can give you free one-on-one counseling about your best choices and help you enroll.
  • When enrolling in a new plan, call 1-800-MEDICARE (1-800-633-5227). According to the Medicare Rights Center, a nonprofit organization that helps seniors and people with disabilities understand their benefits, enrolling directly through Medicare is the best way to protect you from problems with enrollment. Keep careful notes when you enroll, including the plan number, confirmation number, date of conversation, person you spoke with and any other information you were given. You can find an interactive tool on the Medicare Rights website that can help with some of your questions.