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Are there other ways to save money once I reach my Medicare Part D plan's Donut Hole?

Category: The Donut Hole or Coverage Gap
Updated: Jan, 21 2024


Aside from the 75% Donut Hole discount that you receive on all formulary drugs purchased in the Coverage Gap, your Medicare Part D prescription drug plan may also provide supplemental Donut Hole coverage (for instance, generic drug coverage) that will provide you with savings beyond the Donut Hole discount.

However, here are a few additional ways to save beyond paying just 25% of retail drug prices for your formulary drugs.

(1)  Look for lower-costing formulary drugs such as generic alternatives

Even with the 75% Donut Hole discount, the retail cost for other brand-name or generic drugs may be far lower than the retail price of higher-costing brand-name drug equivalent.  If possible, work with your healthcare provider or prescriber and see if any of your expensive brand-name medications can be substituted with lower-cost brand-name or generic medications that are also covered by your Medicare plan.

If necessary, take a printed copy of your Medicare Part D plan formulary or drug list with you when you visit your doctors and ask them to review the covered medications to see if there are any lower-cost alternative drugs.   If you have your mobile phone, you can also use our online Formulary Browser tool that allows you and your doctor to search through your entire formulary online: Formulary-Browser.com.

(2)  Retail Pharmacy Discount Programs

You may be able to take advantage of retail drug discount programs even in the Donut Hole or Coverage Gap - these are programs offered by retail pharmacies and may offer lower everyday pricing for your prescriptions.  You may see additional savings from some large retailers who offer mail-order prescription services (beyond your plan's mail-order service).  We provide our RX-Savings Center that lists medications covered by local retailers:  q1medicare.com/PartD-SearchCompareDiscountRxDrugPrgms.php

(3)  Discount Drug Cards or Programs

Many sources now provide a no-cost drug discount program and you can read more in our FAQs here: Q1FAQ.com/659.  However, these drug discount programs do not work together with your Medicare Part D plan (in other words, you cannot use your Medicare Part D plan and ask for the discount).


(4)  Corporate Patient Assistance Programs

You can research pharmaceutical company prescription drug discount programs (Patient Assistance Programs or PAPs) - especially if you are using a very expensive medication.  Some major drug companies offer special discount programs for their medications.  Be sure to read the "fine print" as many PAPs cannot be used by people who are Medicare eligible.

(5)  State Pharmacy Assistance Programs - SPAPs

You may be able to work with your State Pharmacy Assistance Program (SPAPs) to receive some discounts on your medications.  Unfortunately, not every state has a SPAP.  We have a link to all of the SPAPs here:  q1medicare.com/PartD-State-PharmacyAssistancePrograms.php.

(6)  Look into Medicare Part D Financial Extra-Help

With changes in the economy and your own personal finances, you may qualify for full or partial financial Medicare Part D Extra Help (or the Low-Income Subsidy) with your prescription drug costs.  If you qualify for Extra-Help, you will have your medications covered at a very low cost all the way through the Donut Hole or Coverage Gap.  You can learn more by contacting your local State Medicaid office or the local Social Security office or look on the Social Security website: www.ssa.gov.  We have more information on the Medicare Part D Extra-Help program and the income / asset requirements here:  q1medicare.com/PartD-Financial-Assistance-by-Medicaid.php.
 
(7)  Check Other Sources

Many non-profit organizations provide additional resources for people in the Coverage Gap who are dealing with high prescription costs.  For instance, see the NeedyMeds.org site or telephone your local Senior Center or telephone your Medicare Part D plan or Medicare Advantage plan for ideas.

(8)  Next year, consider switching to another - more affordable - Medicare Part D prescription drug plan

Remember that during the Annual Coordinated Election Period (or annual Open Enrollment Period - AEP) that starts on October 15th of each year, you may be able to change to another Part D plan or Medicare Advantage plan that provides lower costs drug coverage.  You can get an idea of your annual drug costs for some of the larger Part D plans by using the Medicare.gov Plan Finder website or by telephoning Medicare (1-800-633-4227).





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