Resources for prescription drug cost savings

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These strategies and programs below can help you choose your Part D plan and save on your prescription drug costs. If you have a Medicare Part D plan, keeping your costs down may keep you out of the coverage gap, also called the “doughnut hole.” This is the period during which your Part D plan does not pay any benefits. See our section “Medicare Part D: An Overview” for more information.

If you do enter the coverage gap but are unlikely to spend a total of $4,050 of your money before the end of the year to receive catastrophic coverage, the cost-saving strategies may help. In general, these programs do not coordinate with Part D plans.

Free One-on-One Counseling

Free, confidential, unbiased Medicare counseling is available from your local HICAP office (there is one in every county). HICAP is the Health Insurance Counseling and Advocacy Program. Either call 1-800-434-0222 to be connected with your local HICAP or find the local phone number of your county's HICAP office.

Decision Support Tools

Medicare To get information about Medicare prescription drug coverage, you can call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Have your Medicare card, a list of the drugs you take, and the name of your pharmacy ready when you call.

The Medicare website (medicare.gov) has many publications and useful tools to help you, as well as fact sheets, Frequently Asked Questions, and more.

• Prescription Drug Plan Finder — Searches for drug plans offered in your area that meet the criteria you enter.
• Formulary Finder — Helps you find the plans in your area that cover the prescription drugs that you are taking (or their generic equivalent).
• Landscape of Local Plans — Downloadable list will show you the cost and coverage included in each of the 56 PDP plans available throughout the state and in each of the MA-PD plans available in your county. Please note that Medicare is constantly updating their site in order to provide accurate information. Inaccuracies have been found on it.
• Publications — Dozens of fact sheets and tip sheets available for download in English and Spanish. You can also download the "Medicare & You 2008" handbook which includes phone numbers of many plans offered in your geographic area. You can call drug plans for formulary information, although it may be difficult to get the exact information you want. Beware of any heavy-handed marketing or sales of drug plans and keep written records of "promises" made by drug plan representatives (including date, time, promises made and who you spoke with by phone or in person).

Cost Saving Strategies

• Review your Medicare Part D plan yearly to be sure it is the least expensive plan that provides the most comprehensive coverage for your drugs. Call your local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222 or Medicare at 1-800-MEDICARE (1-800-633-4227) and ask for assistance to search for a plan, or use the Medicare Drug Plan Finder on the Medicare Website at medicare.gov.
• Talk to your doctor about switching to generic drugs or other brand drugs that are less expensive. The Consumer Reports Best Buy Drugs (CRBBDs) website provides reports on various drug categories. (Categories refer to drugs in the same class that are used to treat a specific condition or illness such as high blood pressure, high cholesterol, heartburn, or depression). Each report reviews both the scientific evidence on the drugs’ effectiveness and their prices. It then analyzes and compares the drugs within that specific category to come up with recommendations on the “best buy drugs.” Recommendations are based on drug effectiveness, safety, and cost. Visit CRBBDs online at crbestbuydrugs.org.
• Ask your doctor for free samples.
• Check if your plan’s mail order pharmacy would cost less.
• Apply for government or private programs that might reduce your drug costs.
• Contact Patient Assistance Programs (PAPs) listed below that cover your drugs.
• Check the prices for your prescription(s) at several pharmacies. Some pharmacies such as Costco (costco.com) sell their drugs at much cheaper prices than others. You do not need to be a Costco member to use their pharmacy.
• Check out the $4 generic programs at Wal-Mart and Target pharmacies.
• Checkout internet pharmacies that sell drugs online. Some of the online pharmacies are companies that sell discounted prescription drugs from outside the United States. The discounts can be 50% less than the price charged within the U.S. While importing prescription drugs that are not approved by the FDA into the U.S. is illegal, the FDA does allow importation of small quantities of prescription drugs for personal use.

If you are considering ordering prescription drugs from outside the US through an online pharmacy, please note the following:

• Payment to the online pharmacy does not apply toward your Medicare Part D cost sharing, if you have a Medicare Part D plan.
• Some websites may be fraudulent and may not be a pharmacy.
• There are concerns about online pharmacies importing counterfeit drugs.

Government Programs

1. Medicare Low Income Subsidy (LIS) Program (also known as “Extra Help”)

   The LIS assists Medicare beneficiaries with limited incomes to pay for their Medicare Part D plan premium and deductible. Those who qualify for the LIS have lower drug copayments. See our section, “Extra Help with Part D Costs.”

2. Medi-Cal

   People on Medicare and Medi-Cal pay no more than $5.60 per prescription for Medicare covered drugs. (See our section, “Extra Help with Part D Costs”) Medi-Cal covers some drugs not covered by Part D. To apply for Medi-Cal, call your local County Department of Social Services and say you want to start the application process over the phone. More information is on the web at dhs.ca.gov/mcs.

3. California Prescription Drug Discount Program

   At Medi-Cal participating pharmacies, you can get drugs at the Medi-Cal rate plus a 15-cent processing fee. This rate may be lower than the Part D rate. Payments may not apply toward your Part D cost sharing. This program should not be used as a substitute for Medicare Part D. To receive benefits, show your Medicare card at Medi-Cal participating pharmacies. More information is at Prescription Drug Discount Program for Medicare Recipients.

4. Department of Veteran Affairs (VA)

   Eligibility in the VA’s Medical Benefits Package is based on military service. The benefits include prescription drug coverage that is creditable (i.e. as good as or better than Medicare Part D coverage.) To claim the VA benefit, drugs must be prescribed by a VA physician. The program has an $8 co-payment for a 30-day supply of medication at VA pharmacies. Veterans who have the VA Medical Benefits Package may also enroll in a Medicare Part D plan. They may save by filling some drugs through one program and some through the other. Veterans may also choose to have only VA coverage and enroll in a Medicare Part D plan later. Since the VA prescription drug coverage is creditable, the late enrollment penalty will not apply. For more information about the VA Medical Benefits Package, contact 1-877-222-8387 or www.va.gov/healtheligibility/costs/.

5. TRICARE Senior Pharmacy Program

   Uniformed services retirees and their spouses may be eligible for TRICARE, which is part of the Military Health System. TRICARE members who turned 65 after April 1, 2001, must enroll in Medicare Part B. For people who have TRICARE and Medicare, TRICARE pays after Medicare has paid. TRICARE offers creditable prescription drug coverage. Thus, if you have TRICARE, you may decide not to enroll in a Medicare Part D plan. For more information on TRICARE call 1-877-363-6337 or visit tricare.osd.mil/pharmacy.

Patient Assistance Programs (PAPs)

Pharmaceutical companies listed below offer Patient Assistance Programs that provide free or low cost drugs to qualified individuals. Each program has its own eligibility criteria and application process. Some provide drugs only if the drugs are not on your Medicare Part D plan’s formulary, or if you are in the coverage gap, or not enrolled in a Medicare Part D plan. Call the company for PAP details.

Medicare can tell you which PAP covers your drug, who qualifies and how to apply. Call 1-800-MEDICARE (1-800-633-4227) and ask for assistance, or visit medicare.gov/pap. Note: If a PAP pays for your drugs, their payment will not count toward your cost-sharing in your Medicare Part D plan.

Additional Information

The websites listed below contain searchable databases with information on prescription drug resources and financial assistance with prescription drug costs. Many specifically help you find patient assistance programs (PAPs) that offer your drug(s).

• pparx.org – Partnership for Prescription Assistance offers a single point of access to more than 475 public and private patient assistance programs, including more than 180 programs offered by pharmaceutical companies. You can also access the Partnership for Prescription Assistance by phone at 1-888-4PPA-NOW (1-888-477-2669), sponsored by PhRMA (the Pharmaceutical Researchers and Manufacturers of America).
• RxHelpforCa.org – RxHelpForCalifornians is a website that provides access to public and private assistance programs to help low income and uninsured Californian residents get free or discounted brand name drugs. Search for programs using drug names or active ingredients. You can call Rx Help For Californians at 1-877-777-7815.
• rxassist.org - RxAssist offers a comprehensive database of patient assistance programs, as well as practical tools, news, articles and up-to-date information on how to access assistance from nearly 100 companies and more than 700 medications. Searches can be performed on a multitude of variables: company name, brand name drug, generic name, drug therapy class.
• rxhope.com – The Rx Hope website allows patients and their providers to apply for patient assistance programs offered by hundreds of manufacturers, and find information on programs offered by State and Federal government and by pharmaceutical companies. A Patient Assistance Information section gives information about particular products or companies.
• needymeds.com – The NeedyMeds website allows you to enter your medication to find patient assistance programs for that specific medication. It has an alphabetical list of approximately 1,000 prescription medications.
• benefitscheckup.com – Benefits Check Up is a service of the National Council on Aging.  The website has applications and fact sheets for over 250 programs that will help pay for prescription drugs, and health care costs, as well as applications for the LIS (also known as “extra help”.) It helps find programs for people ages 55 and over that may pay for some costs of prescription drugs, health care, utilities, and other essential items or services.

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Page updated April 29, 2008