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Smart Strategies for Managing Pharmacy Costs

Have you ever had sticker shock at the pharmacy? Navigating the complex world of prescription medications can be daunting, with the need to understand differences in drug types, pharmacy pricing, insurance nuances, and more. Here are some tips for managing costs, whether you’re dealing with private insurance or Medicare, or paying out-of-pocket. 

Understanding drug types: brand name vs. generic 

Brand-name drugs (such as Lisinopril and Xanax) are the original products launched by pharmaceutical companies with exclusive rights for a period. Once these rights expire, other manufacturers can produce the same medication as a generic, typically at a significantly lower cost. Generics are just as effective and usually less expensive. 

Pharmacy prices vary – so shop around 

Many people are surprised to learn that the cost of a prescription can vary depending on where it’s filled—even with insurance or Medicare coverage. Pharmacy prices can vary widely even within the same city due to different business costs, insurance agreements, and other factors.  

The solution is to shop around just as you would for other purchases. It can save you money on both an existing prescription that you refill every month and on a new one. Here are some options: 

• GoodRx and RxSaver will compare the price of your prescription at pharmacies near you.  

• Consider an online or mail order pharmacy. Several are available, and they ship your medications to you. The U.S. Food & Drug Administration provides safety guidance.  

• Warehouse clubs like Costco and Sam’s Club are known for lower medication prices. Bonus: You don’t need to be a member to use their pharmacy services. 

• Drug manufacturers often offer discounts or rebate programs for brand-name drugs on their websites. 

Make the most of Medicare benefits 

Medicare beneficiaries should pay close attention to their coverage options under Part D (prescription drug coverage) and Part B (limited prescription coverage for drugs administered in a clinical setting). 

Medicare Part D is essential for covering medications, but it varies based on the chosen insurance provider. Each plan has its formulary, and drugs are placed in different tiers, affecting your co-payments. During the annual enrollment period, review your plan choices to ensure your prescriptions are covered at the lowest possible cost. 

Key Medicare strategies 

• Review your plan every year. Always review your plan during the open enrollment period to ensure it still meets your needs, especially if your prescriptions have changed. 

• Use Medicare’s preferred pharmacies. Some plans offer lower prices at specific pharmacies. 

• Extra Help program: For those with limited income, this program for Medicare Part D can help reduce costs significantly. 

Medication “shopping” is like making any other purchase—it’s best to stay informed and make the most of available information and resources. LifeCare Advocates’ Life Care Managers can help their clients with price comparisons and understanding their insurance coverage. Contact us to learn more about our services.