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Medicare Prescription Drug Cost

| June 14, 2023


Once enrolled in a Medicare Part D Prescription plan, some beneficiaries find it difficult to cover the costs of their prescriptions. In many cases these prescriptions were affordable until the beneficiary reached their annual spending limit and entered what is called the coverage gap. Many people still refer to this stage as the donut hole. Either way, they are the same thing. The coverage gap stage begins after the beneficiary and your drug plan have spent a certain amount for covered drugs. That amount for 2023 is $4,660. This amount can change every year. Once you are in the coverage gap, you’ll pay no more than 25% of the cost for your plan’s covered brand name prescription drugs. Even though you’ll only pay 25% of the drugs costs, almost the full amount, 95%, will count towards getting you out of the coverage gap. Once your total out of pocket reaches $7,400 in 2023, you will leave the coverage gap and enter the Catastrophic Stage of Part D. At this stage you will pay either 5% of the retail cost or a very small copay. In 2023 the copay is $4.15 for generics and $10.35 for brand name drugs. So, what can you do to control your prescription costs?

Here are a few ideas to consider that may to help to lower your costs.

Consider switching to a generic or other lower cost prescriptions.

     There may be generic or less-expensive brand-name drugs that would work just as well for you as the ones you are currently prescribed. You should talk to your doctor to find out if either of these are an option for you.

Pharmaceutical Assistance Programs

     Some pharmaceutical companies offer programs that help to pay for part of the costs for their medications. Not all companies offer programs and different companies have different programs. If you have an expensive drug on your list, reach out to the manufacturer and see if they have a program that you may be eligible for.

State Pharmaceutical Assistance Programs

Many states have programs that help in paying the costs of your prescriptions. States may have a few options like a Medicare Savings Program or Low-Income Subsidy. You should reach out to your state to see which programs are available to you.

You might also be able to lower prescription costs by using mail-order pharmacies.