Understanding Prescription Discount Cards For 2016 and 2017
One of the most common complaints from seniors regarding their healthcare is the ever-rising cost of prescription drugs. Specifically, they do not appreciate how the related secondary and budgetary strains that these costs place on the quality of life they live.
Prescription discount cards as a way to help avoid the Medicare donut hole
These issues are particularly prevalent when Medicare participants are within the coverage gap (donut hole). This is the period of time after Medicare and the participant jointly pay $3,310 a year in 2016 and $3,700 a year in 2017 on prescription-related costs. The donut hole includes copays, deductibles and the cost of the drugs.
After this threshold is met, the percentage of generic and brand name drugs that Medicare covers is greatly decreased. And, this leaves seniors with more of the tab to pick up for the drugs that they need every day. As a result, it is not unusual for seniors to either take improper dosages of prescribed medications (in an effort to reduce costs). Or, they do not take them at all, because their percentage of the cost of the drug is simply too great.
In addition, there are some seniors who simply choose not to take on prescription drug coverage under either Medicare Part D or a Medicare Advantage plans. If this is the case, many of the prescription drug discount programs offered in the Marketplace today will be of great benefit. That’s because they often do not apply to participants who have separate drug coverage.
Under the Affordable Care Act (ACA) law, the threshold before a senior reaches the donut hole will increase. Seniors will see a $390 a year bump between 2016 and 2017, which means that Medicare will cover more of the costs so it takes longer for the senior to reach the donut hole. The percentage that Medicare will cover while the senior is within the donut hole will also increase until 2020. At that point, Medicare and manufacturer discounts will be responsible for 80 percent of the total costs, and seniors will only be responsible for 20 percent of the cost. Until that point in time though, seniors rely on programs like Prescription Drug Discount Cards and manufacturer discounts to subsidize the total costs of medications.
Manufacturer discount programs were first created after advocacy groups placed significant pressure on the federal government to offer assistance programs to qualified lower-income seniors. These seniors would particularly benefit from receiving discounted or free prescriptions. For some people, these manufacturer-based drug assistance programs have literally produced longevity and life-saving benefits. Unfortunately, not everyone qualifies for the assistance.
Since the inception of these drug manufacturer assistance programs, pharmacies have followed suit. They began offering Discount Prescription Drug Card programs, as well. The trend of Discount Prescription Drug Cards has somewhat muddied the waters for many consumers seeking to reduce their prescription drug costs, as not all cards are similar. These pharmaceutical discount programs need to be carefully scrutinized.
Also, be aware that some programs, like the Rx Access Card, are only available to non-Medicare participants. Therefore, it’s important to read the eligibility requirements of each program. That way, you do not accidentally sign up for a program that will ultimately not provide you any benefits because they do not participate with the Medicare program.
It is also important to note that there are some scam prescription drug card programs out there. These programs charge a flat fee or reoccurring monthly fee and only provide you with discounts that are already available for free or at discounted prices to every consumer. Be careful to thoroughly review any discount prescription drug offers and compare. You may also want to research the company with the Better Business Bureau before signing up.
The following information outlines different types of discount programs available to Medicare participants. There are many more out there, and new ones are being introduced into the market every day. So, it is important to always do your research.
Medicare Part D
The Medicare Part D program provides prescription drug coverage to its participants. The total cost of generic and brand name prescription drugs is shared with the Medicare program. Medicare Advantage (Medicare Part C) plans also offer prescription drug coverage, so that prescription drugs are equally as affordable for participants. Prescription drug discount programs are considered private and separate from Medicare plans. But it is important to at least include this category in this review for informational purposes.
Manufacturer Discounts – Many prescription drug manufacturers offer discounts direct to consumers for their drugs. In many instances, this is the best way to get the deepest discount on the drugs you use and need everyday.
- The GlaxoSmithKline Prescription Drug Assistance Program is available for drugs offered by this manufacturer.
- In addition to receiving discounts on their drugs, they also offer cost-saving coupons and vouchers that will help decrease a participant’s out-of-pocket costs. The coupon program is available to people with health insurance; however, some of the other programs are only available to those without any insurance (Part D or prescription drug coverage through Medicare Advantage).
- There is a program called GSK Access, which provides free drugs to Part D participants. But you must have spent at least $600 on prescriptions during this calendar year, live in the United States and meet the plan’s income requirements, which can be viewed on their website.
- The website asks people to contact them at (866) GSK-FOR-U (475-3678) in order to enroll in the program.
- Roche Patient Assistance Foundation is available to people who: do not have Original Medicare or Medicare Advantage; or any other insurance policy; or have a plan that does not cover a particular medication; or have a high co-pay or coinsurance plan with your Medicare Advantage plan.
- Pfizer offers a manufacturing discount program called the RxPathways. Seniors on Medicare may use it to help subsidize the cost of their prescription drugs made by Pfizer.
- Pfizer offers two different types of programs. One program is called Group A and covers primary care medications that a doctor may prescribe. Group B covers Pfizer specialty medications.
- Participants can use the Pfizer RxPathways program even if they have prescription drug coverage.
- Pfizer also offers the assistance of counselors to help explain to seniors the costs and discounts offered on their drugs.
- If part of the program, the Medicare participant could have access to 50 of Pfizer’s medications for free and discount savings to more than 95 of their other drugs.
- There are a few limitations to this program, which are that participants must meet certain income limitations based on their family size. These requirements can be found on their website. Additionally, the applicable medications can only be used for outpatient treatments.
- You can enroll in Pfizer’s program on its website, www.pfizerrxpathways.com.
- Merck also offers a Prescription Discount Program for Medicare participants. Merck’s program offers between 15-40 percent on its drugs, depending on the participant’s needs. It also offers free enrollment and does not require annual membership fees for the lifetime of the program. And, this program offers its discounts to most pharmacies in the United States.
- There are limitations to Merck’s program. If you are signed up for a private prescription drug program through Medicare Advantage or Medicare Part D, you cannot use the Merck Prescription Discount Program. Therefore, if you have enrolled in Original Medicare or Medicare Advantage plan without any coverage for prescription drugs, you can apply for Merck’s program. You also cannot use the Merck Prescription Discount Program in combination with any other discount or coupon.Prescription drug manufacturers
Before using a discount prescription drug card, check with the manufacturer of the drug you are taking. This will allow you to determine whether you qualify for free or greatly reduced drug prices through their private assistance programs. Under the Affordable Care Act and previous provisions under Medicare, manufacturers must automatically provide certain discounts to the drugs purchased by Medicare participants; this makes them more affordable. Some manufacturers offer separate discount programs, a few of which are outlined below.
Big box stores – Some chain stores with pharmacies offer discount programs on prescriptions, as well. Make sure you understand the rules of pharmacy or department store discount prescription drug cards. Some pharmacy discount prescription drug cards have eligibility restrictions; i.e., income caps, age limits or family plans covering children. While these types of discount prescription drug cards often are free, some do charge a small fee. As such, be certain to understand any associated costs. A few of the chain store pharmacy discount clubs are explained below.
- Kmart Pharmacy Prescription Savings Club
- This program offered by the chain store, Kmart, aims to lower the costs of drugs purchased in their pharmacy.
- Kmart’s Savings Club offers certain 30-day supplies of generic drugs for as little as $5.00 and some 90-day supplies of generic drugs for as little as $10.00. The club also offers discounts on brand name drugs and generics that are not on their preferred list, along with savings on immunizations.
- The enrollment fee for the Kmart Pharmacy Prescription Savings Club is an annual $10 enrollment fee. This will be added to the cost of the first prescription you purchase under the program.
- You will receive the Savings Club card in the mail, as well.
- There are some limitations to this program. It is not offered in every state and guidelines for the program in some states vary.
- You can enroll in the club by visiting your local Kmart pharmacy.
- Sam’s Club Plus Member Pharmacy Discount
- Sam’s Club offers discounts on the drugs purchased through their pharmacy. The program boasts that participants can save up to 40 percent on certain generic drugs. They also have a program for certain other generic drugs, whereby the cost is only $4.00.
- The discount program also offers 8 percent discount on certain brand name drugs. They also a program called the Extra Value Drug List that provides even more discounts on certain drugs.
- Again, there are limitations to this program. For instance, you must be a Sam’s Club member in order to take advantage of the savings. Additionally, these discounts are not available to participants of a prescription drug program. Accordingly, if a person has Medicare Part D or a prescription drug program through their Medicare Advantage plan, they will not be able to benefit from the savings through the Sam’s Club discount program.
- Target Prescription Savings Program
- This program is provided through the Target pharmacy and requires a $10 annual fee in order to enroll and receive the benefits.
- The program offers discounts between 10-50 percent on the retail value of generic and brand name drugs.
- You can enroll for this program at your local Target pharmacy.
- Unfortunately, this program cannot be combined with insurance. This means that a person with Medicare Part D or a prescription drug program through Medicare Advantage is not eligible for the discounts through Target’s program.
Special interest groups – Groups such as AAA and AARP offer discount prescription drug programs to its members. However, some do require you to pay for your membership in order to receive the benefits. There are numerous other special interest groups that offer prescription drug discount programs. For instance, the United Way offers programs in different cities and states that it pairs with private discount card programs. In addition to researching national special interest groups, it would also be helpful to determine whether your state or county offers any prescription drug discount programs.
- AARP Prescription Discount
- Members can receive prescription drug discounts through the AARP program without filling out an application or paying an annual fee.
- The program qualifies recipients to save up to 38 percent from more than 64,000 pharmacies across the country.
- You can print the AARP Prescription Discount ID card right off of the Internet. Or, you can download the mobile application and instantly begin receiving savings.
- Members can use this discount cart to receive savings on all Food and Drug Administration (FDA)-approved drugs that are not covered by your insurance company (Medicare Part D or Medicare Advantage Plan).
- AAA Prescription Savings
- This savings plan is only available to AAA members and does not require any additional flat or annual fees.
- Members who present their AAA card to the pharmacist will receive the associated discount.
- The AAA Prescription Savings program cannot be used in conjunction with an insurance policy. However, if there is a drug that you need that your Medicare Part D or Medicare Advantage plan does not cover, you can use your AAA membership card to receive discounts on the drug.
- There are over 59,000 retail pharmacies that accept AAA membership cards across the nation.
- AAA estimates that their members receive on average 24 percent savings on the retail price of the prescription drugs.
Privately offered prescription savings card – There are private companies that partner with prescription drug discount companies to bring consumers access to additional point of sale savings.
- HealthNetwork Prescription Savings Card
- The HealthNetwork Prescription Savings Card provides consumers with an easy-to-download and print prescription savings card that is accepted by most pharmacies, nationwide and will provide some of the best point-of-sale discounts. HealthNetwork is able to offer some of the most competitive savings with their prescription savings card because they pass any commission that they would receive under their joint partnership with the prescription drug discount company, on to the consumer.
When researching these prescription drug programs, you should consider whether you qualify in the first place. As you can see from the above list, certain programs will not work in conjunction with prescription drug insurance plans.
In addition, before you start researching, it is a good idea to determine, whether you are willing to pay a flat or annual fee. Some discount prescription drug plans that require a yearly fee or recurring monthly charge can actually provide lower cost drugs. This is due to the fact that they contract with particular pharmacies to receive lower pricing. These plans can vary in restrictions and price; restriction-free plans are typically the more expensive. But they may still save you money in the end. Remember to always compare.
Checklist for deciding whether a discount Rx drug plan works for you
- Is the card free? If not, what is the charge for the discount card? Is there a one-time charge or is it a recurring monthly fee?
- Where is the card accepted? If the discount prescription drug card is only accepted at particular pharmacies, and there is not one nearby, are you willing to change your pharmacy? Consider that the cost of gas and your time to get to the pharmacy may outweigh the savings you may receive under that particular discount program. The prescription drugs you need may only be covered by mail order pharmacies. So, be aware of hidden costs and ask if there are any, such as shipping charges, handling fees or shipping minimums.
- Check to see that the specific drugs you are taking are covered under the discount prescription drug plan in the first place. Determine whether the program also covers generic drugs, even if you are not currently taking any. You may want to have this information for the future. Also, knowing the answer to this may be an added factor in your decision-making process.
- Compare costs. If you are choosing to a discount program through a retail pharmacy, you should compare the cost of your discounted prescriptions with competing retail pharmacies in your area. If you are dealing with a mail order pharmacy program, make sure that you calculate all of the associated costs, like shipping fees.
- Narrow down your list. Now that you know whether your prescription drugs are available through a discount prescription drug plan, your next step is to check to see if you are eligible. Make sure you are eligible for each card you are considering. Only then can you decide which discount prescription drug plan or plans best suit your needs.
Helpful tips and websites to learn more about discount prescription drug plans:
- Many states offer pharmaceutical assistance programs to those who qualify. Find out if your state has one and inquire about your states eligibility requirements. You can find out what assistance is available to you by going to Medicare.gov.
- Apply for the Extra Help program from Medicare. If you meet the requirements of this assistance program, you can qualify to receive prescription drugs priced at (based on 2015) $2.65 for generics and $6.60 for brand name covered prescription drugs. There are income and resource limitations to qualify. For example, some people pay only a portion of their Medicare drug plan premiums and deductibles, based on their income. Find out if you qualify by contacting your State Medical Assistance (Medicaid) Office or State Health Insurance Assistance Program (SHIP).
- Find out if the drug manufacturer of your prescription drugs offers help to pay for them by going to Medicare.gov. Look up each drug you are taking or need to be taking.
- People with certain diseases, such as ESRD, HIV or AIDS or cancer, may also receive assistance in paying for their medications. Go online to your disease’s nonprofit organization to find out about assistance programs that may be available to you.
- Generic drugs can substantially reduce your prescription drug costs. Ask your doctor if there is a generic substitute for your particular prescription medications.
- Ask your doctor if there is a less expensive brand (or manufacturer) for your prescription drugs.
- Consider using mail order pharmacies. Be aware of unknown online prescription drug manufacturers, pharmacies or companies from other countries. They may: provide counterfeit drugs; not be FDA-approved; or contain substandard ingredients and or harmful contaminates. Ask your doctor to recommend an Internet pharmacy before ordering ANY drugs brand name or generic online.
Some people automatically qualify for extra help
You will automatically be covered for the Extra Help if you have Medicare and meet any of the below listed qualifications:
- You already have full Medicaid coverage
- Are receiving help from your state Medicaid program to pay for your Part B premiums (in a Medicare Savings Program)
- Are already receiving Supplemental Security Income (SSI) benefits
Just because you have automatically qualified this year for the Extra Help program does not guarantee that you will qualify next year. If there were changes to your income or resources, you will need to reapply. If this, in fact, has occurred, one or all of the above-mentioned programs will notify you. You will receive a notice by the end of September if you no longer qualify to be automatically enrolled. You may still qualify for the Extra Help programs, but you need to apply to find out.
Tips on what NOT to do if you can’t afford your medications
If you cannot afford your prescribed drug, the first thing to do is to inform your doctor or healthcare provider, hospital, or clinic as soon as you become aware of this fact. They may be able to prescribe a different medication or treatment regimen.
Do not stop taking your medication, alter or skip a dose. This is because it could be very dangerous to your health or render the medication ineffective altogether.
Always consult your physician or trusted healthcare provider, such as a hospital social worker, if you are having difficulty obtaining discount prescription drug assistance. They are often the best informed on the latest and greatest prescription drug assistance program. And, they may be aware of upcoming or little-known programs.
Finally remember the old adage: If it sounds too good to be true it probably is. Instead, be sure to stay with trusted providers of any healthcare products.