How to Save on Prescriptions with Pharmaceutical Assistance Programs
The high cost of prescription drugs is cause for alarm for all of us, but especially those who are taking expensive medications. A Part D prescription drug plan will help, but those of you who have experience with expensive medications know the pitfall of every Part D program: the donut hole.
You all are also probably aware of the significant increase in the Part B premium in 2022. There were changes made to the Part D deductible and coverage thresholds as well, which are going to increase our out-of-pocket expenses in 2022.
Let's review the coverage thresholds of the Part D program and then discuss how you may be able to decrease the cost of your prescription medications.
Part D Prescription Coverage Phases
There are four coverage phases in every Part D plan.
The Deductible Phase
The new deductible for Part D plans in 2022 is $480, which is up $35 from 2021. Many common, generic medications won't apply to your deductible. For instance, if you are on blood pressure medications, you'll probably be able to get these refilled without first meeting your deductible. Most Part D plans waive the deductible for prescriptions that are in their Tier 1 and sometimes Tier 2 categories.
If you are taking a prescription in a higher tier, you'll need to meet the $480 deductible before your coverage begins.
The Initial Coverage Phase
Once you've met your deductible, the initial coverage phase begins. Your prescription drug coverage will depend on the specifics of your plan, but you will be responsible for either a copay or coinsurance cost during your initial coverage phase. You'll remain in this phase of coverage until you and your Part D plan have spent a total of $4430 on prescription drugs.
The Coverage Gap or Donut Hole
The coverage gap begins when your total expenses (you and your drug plan's cost) have reached $4430 in 2022. (The coverage gap began at $4130 in 2022.) Once you're in the coverage gap, you'll be responsible for up to 25% of the cost of your medications. This is a significant increase in out-of-pocket cost compared to what you were paying during your initial coverage phase.
You will remain in the coverage gap until you have spent $7050 on prescriptions. This does not include any payments that your Part D plan makes, nor does it include your drug plan premiums, but it is solely your own out-of-pocket costs. This number increased quite a bit from 2021 when it was $6550.
The Catastrophic Coverage Phase
Once you've spent $7050, you'll enter the catastrophic coverage phase. During this last phase, your Part D plan will revert to paying most of the cost for your prescriptions. Your copayment or coinsurance amount should be relatively minimal.
Pharmaceutical Assistance Programs
There are several ways to get financial assistance for your prescriptions. If you do not qualify for any federal or state prescription assistance programs, the next best resource is pharmaceutical assistance programs.
Medicare.gov has a helpful section of their website that allows you to enter the name of the medication you are taking and see if there are any pharmaceutical assistance programs available for that specific drug. You may find manufacturer discounts or coupons that allow you to purchase the medication at a very low cost, or at least much less than it would be otherwise.
Other Prescription Drug Savings Options
Another option to search for savings on your prescription drug costs is through GoodRx. Simply get a GoodRx account and type in the name of your medication. GoodRx will tell you if there are any coupons available.
The only catch when using a program like GoodRx is that you cannot use it and your Part D plan at the same time. Because of that, any prescription expense you have outside of your Part D program will not count towards the deductible or catastrophic coverage levels.
