Medicare Part D: Shopping for $4 Medications

By Mary Jane Stern

Where do you shop for your $4 generic medications? Do you shop at the same pharmacy and run the charges through your Medicare Part D plan? Or do you shop at a different pharmacy and just pay cash for them?

Why would I ask you these questions?  A few years ago we ran all of our prescriptions through one pharmacy using our Medicare Part D plan.  Then one day we realized that in many instances $4 is not what is being charged against the Total Drug Cost. Instead, it’s a retail price on the generic drug being charged against the Total Drug Costs.

You take a prescription drug and it is in the pharmacy’s list of $4 generic drugs and your co-payment is $4.  When you get your Medicare Part D Explanation of Benefits you might see a charge of $15-$20 or more for that medication. That $15-$20 is applied to your Total Drug Cost and can put you into the Coverage Gap perhaps a few months sooner.

What Can You Do?

As much as it is an inconvenience, shop at two different pharmacies.  Don’t use your Part D plan for the $4 generic drugs.

The reason I recommend two different pharmacies is because once the pharmacy has your insurance information, it’s almost impossible to get them to stop running the $4 generic charges through your plan.

Just go to another pharmacy offering $4 generics and pay cash and these charges are never applied against your Total Drug Cost in your Medicare Part D plan.

It’s really worth the inconvenience of shopping at two pharmacies. One for $4 generics and one for brand name medications.  It won’t be until 2020 that the coverage gap is closed.  In the meantime, we need to look at ways to stay out of the Coverage Gap.

Check around and find out what some of the pharmacies in your area are offering.  One pharmacy in our area has a “no cost” antibiotic prescription program and they offer certain diabetes medications at no cost.

Let us know if you have any strategies for staying out of the Coverage Gap and let us know if pharmacies in your area have any prescription programs.  We would love to hear about them and share with our readers.

1 Response

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