March 14, 2019
Drug Discounts, Other Help Available
Consumers are powerless to control spiraling medication prices, but low-income, uninsured and under-insured individuals can often get help paying for their drugs.
The help, in the form of subsidies or prescription price reductions, comes from four sources. The first is exclusively for seniors on Medicare, but the rest are available to everyone.
Medicare’s Extra Help program provides up to $4,900 to subsidize retirees’ drug copayments and Medicare Part D premiums. Individuals are eligible for this assistance if their income is less than $18,210 and the value of their investments, bank accounts and other assets is under $14,390. The limits for couples are $24,690 in income and $28,720 in assets. Retirees who own their homes do not have to include the property’s value in this limit. Social Security’s website explains what does and does not count as assets.
Social Security takes the applications for this Medicare program. Applications can be submitted either online (SSA form 1020) or in person by making an appointment at a local Social Security office. Social Security also notifies seniors about whether they qualify.
Price discounts in an app
If your drug is not covered by your health insurance, Consumer Reports suggests trying two cell phone apps (or go online) to search for the lowest-cost prescriptions at various pharmacies in your area. On the apps – GoodRx and BlinkHealth – search your drug name and dose and enter your zip code to find the discounted prices, which can vary dramatically. These companies act as middlemen between consumers and Pharmacy Benefit Managers, which buy generic and brand-name medications in bulk from manufacturers and pass the volume discounts on to consumers. GoodRx provides a coupon that can be saved on a phone or printed out for the pharmacist. BlinkRx requires consumers to pay for the drug on its website and provides a voucher for the pharmacist. These cash prices will not be run through insurance – and won’t count against your deductible – said Lisa Gill, Consumer Reports deputy editor and a specialist in medication pricing.
Walmart also offers discounts on generic drugs, and Costco has very low retail drug prices. Which option is best for you? “It’s going to depend on which medication you take and probably where you live,” Gill said. Not everyone will have success in reducing their costs but, she added, “if the drug’s not covered by insurance, it’s worth trying.”
Drug company discounts
For brand-name medications, consumers may have more luck checking for a manufacturer discount. RxAssist is a one-stop website for consumers of all ages applying for discounts or free medications directly from pharmaceutical companies. To check whether assistance is available, enter a specific drug’s name on RxAssist’s website – say, Lantus, the insulin. When the user is sent to the next page, they can click on the drug’s name to be forwarded to a page with the drug maker’s application form and program guidelines – in this case, Sanofi. To qualify, most companies require that individuals have low incomes, lack medical insurance, or are underinsured, said Shirley Titus, RxAssist’s Program Coordinator. But Sanofi’s Lantus page says that it may help some Medicare beneficiaries, too, if they are “ineligible for [Sanofi’s] low income subsidy and have spent at least 5% of their annual household income (out of pocket) on medications.”
RxAssist’s database also provides information about copay assistance programs and about a drug discount program for the non-profit pharmacy RxOutreach. RxOutreach helps patients find lower-cost alternatives to expensive medications. For example, there are several generic options for Plaquenil, a common treatment for autoimmune conditions. Patients follow the same process: enter the brand-name drug – Plaquenil – and follow the links to a page detailing RxOutreach’s applications, requirements for prescription assistance, and other information. (As a last resort, Titus said patients can also call a drug company directly. RxAssist provides a directory with phone numbers for RxOutreach and the drug companies.)
Finally, anyone can print out and use RxAssist’s discount card. Titus said patients can call the number on the card – 877-537-5537 – to get information about drug prices and pharmacies in their area that participate in the program. The pharmacies include both neighborhood stores and major companies like CVS, according to RxAssist.
Pharmacies will negotiate prices
A recent blog post highlighted a strategy for reducing drug costs that not everyone is familiar with: negotiate with your pharmacist.
In the article, California pharmacist Mohamed A. Jalloh explains: “If you process a prescription through your insurance – whether under an employer’s health insurance or Medicare drug coverage – the price may be higher than paying straight cash for the medication.” So ask the pharmacist if he or she can help. “Anyone can do this,” Jollah said.
In the blog’s comment section, numerous readers weighed in with their own tips or described their successes and failures in cutting their medication costs.
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