Happy May Day! Medicare drug plans seem designed to confuse people.  

When filling a prescription—especially an expensive one—it pays to compare prices. Be sure to check your insurance co-pay alongside discounted cash prices available through services like Amazon Pharmacy and GoodRx.

Keep in mind: when you use these cash-price options, your purchase is not processed through your prescription drug plan. That means the amount you pay will not count toward your Part D annual out-of-pocket maximum of $2,100. On the other hand, prescriptions processed through your insurance do count toward that limit.

If you’ve already met your deductible or have low co-pays, using your insurance is often the most cost-effective choice for medications covered under your plan. And once you reach your annual out-of-pocket maximum, your covered medications will cost you nothing for the remainder of the year.

It’s also smart to compare prices between pharmacies. Costs can vary—even for the same medication—because each pharmacy negotiates its own pricing with insurance carriers. For higher-cost prescriptions, consider asking your doctor to send the prescription to more than one pharmacy so you can compare and choose the best price. For my mom’s medications, I compare her main one, CVS, to a small little pharmacy in Fullerton where I have gotten them cheaper. If some medical assistant at the doctor’s office says they can only send to one pharmacy, that is not true at all and pure laziness. You tell the doctor to do it then.

If a medication is not covered or is particularly expensive, ask your doctor or pharmacist about lower-cost alternatives. Doctors don’t always know what your specific plan covers or what your out-of-pocket cost will be. Even goodrx.com, google search or ChatGPT will give you alternative option if available. If you must have that drug, it’s not covered and expensive, go to the drug manufacturer and inquire about discounts or assistance. 

To check your coverage, keep a copy of your plan’s formulary (drug list) handy. This document shows all covered medications, their tier levels, and whether a deductible applies. You can download it from your insurance carrier’s website. Another easy option is to visit Medicare.Gov, where you can search for your medication, confirm coverage, and estimate your co-pay. Lastly, calling your carrier’s customer service will work also. 

Taking a few extra minutes to compare options can lead to significant savings—while ensuring you get the medications you need at the best possible price. And of course you got me you can call/email and I am glad to help:)

Call me to answer your questions or get guidance on these confusing Medicare drug plans at 949-248-3112.