• Brad Gunning

Can you ask your Part D plan to reduce drug co-pays?

We are intimately familiar with the challenges seniors face regarding the cost of their medications. Sure, certain common generic medications can be free or inexpensive with a Medicare Part D plan in place, but it's the expensive brand name drugs that cause financial hardship.


The full retail cost of an expensive brand name drug can cost thousands of dollars for a one month supply. Regardless of having a good Medicare Part D plan, the cost of the co-pay can often be hefty even if the co-pay is far less than the full retail cost of the drug. It's not uncommon for a 90 day supply co-pay on a more expensive drug to cost more that $500 through a Part D plan.


Fortunately, there are some solutions to help reduce drug co-pays in the event of expensive medications. We've assisted clients in implementing these solutions and saved them thousands of dollars.


Solution 1: Ask your Medicare Part D plan for a coverage determination or tier exception


All Medicare Part D plans have a system in place for processing and granting coverage determinations and tier exception requests. If your doctor prescribes an expensive medication, you can contact your Medicare Part D plan and ask for a tier exception for the medication in question. The insurance carrier will likely provide a form that needs to be completed by your doctor. They will ask about alternative medications and some specifics about your medical history. Upon submission of the form, the insurance carrier will make a determination of whether to grant a tier exception. If the insurance carrier initially declines a request for a tier exception then you can request a redetermination which is sometimes met with more success. We have had quite a bit of success in assisting our clients with this process.


Additional note: If your prescribed medication is expensive because it is not listed on the Part D plan's formulary, then you will need to request a formulary exception, which is a similar process as described above.


Solution 2: Search for coupons on GoodRx.com


Prescription coupon websites such as GoodRx.com offer discount coupons for expensive medications. In some cases, the cost of the prescriptions with a coupon are lower than with insurance. If you are budget minded, it can be a good idea to check your prescription cost on GoodRx, even if your co-pays are already manageable.


Solution 3: Ask for assistance from prescription drug manufacturers


Pharmaceutical companies offer financial assistance programs for expensive medications. If you are on a medication that is breaking the bank, we suggest researching the drug manufacture's financial assistance programs. A simple Google search of the drug name will make it easy to determine the manufacturer and any programs they have that can help reduce the cost.


Solution 4: Ask your doctor


Your doctor is the best person (and likely the only person) qualified to make a recommendation about alternative treatments or medications. If you inform your doctor that a medication is too expensive, even with insurance, they might be able to recommend and prescribe an alternative medication. Doctors are often unaware of the high co-pays associated with prescription drugs and keeping them apprised can be a way to make sure they are aware when the cost of a drug causes financial burden. If a doctor is unaware that a drug is expensive they are less likely to keep an eye out for lower-cost alternatives.


#Rx #prescriptions #PartD

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