Healthcare Educators


How to Control Prescription Costs

by | Mar 11, 2024

If you are like many seniors on a fixed income, you may be finding it difficult to afford your prescription medications. As drug prices continue to rise, a growing number of older adults are making tough choices on how to stretch their dollars. Some are choosing to cut back on other basic needs (such as groceries) to pay for their prescriptions. Others are not taking their medications as prescribed – skipping, delaying, or cutting back on the prescribed dosage.

There is some good news for seniors who need help managing the high cost of their medications.

How the Government Is Helping to Lower Your Prescription Costs

The Inflation Reduction Act of 2022 has several provisions directed at lowering the cost of medications for seniors. Some are already in place and others will be rolled out in the near future:

  • In 2023, insulin costs were capped at $35 per month for any insulin your insurance carrier covers.
  • In 2024, the 5% coinsurance for those individuals who entered the catastrophic phase of Part D coverage gap was eliminated. Once an individual’s out-of-pocket spending reaches $8,000, they will pay nothing for their Part D medications for the rest of the year.
  • In 2024, income thresholds have been lowered to make more people eligible for Extra Help – the Medicare program that helps people with limited income and resources pay their Part D out-of-pocket costs.
  • In 2025, out-of-pocket costs for Part D prescription drugs will be capped at $2,000 per year, effectively eliminating the coverage gap, or “donut hole”.
  • In 2026, we will begin to see lower drug prices as a result of Congress giving Medicare the power to negotiate with drug manufacturers to bring down the cost of high-price drugs that treat chronic conditions.

How You Can Lower Your Prescription Costs

There are also steps you can take that may lower the cost of your medications:

  • Review your insurance coverage – Deductibles, copayments, and coinsurances vary by plan and insurer, as do drug formularies. If you feel you are paying too much, compare plans and insurance carriers. You may find a different plan with lower drug costs. It’s important to do this every year, especially if your medications have changed.
  • Consider generic drugs – Generic drugs are typically much more affordable than brand-name medications. If you are on high-priced medications, talk to your doctor about whether a lower-cost generic drug could be an option for you.
  • Compare Pharmacies – Since prices for the same medication vary between pharmacies, it may be worthwhile comparing prices.

A variety of other discounts programs also offer cost savings:

  • Drug manufacturer discount coupons
  • Discount programs through large retail pharmacy chains, such as Walgreens, Walmart, CVS, etc.
  • Online pharmacies, such as GoodRx, Blink Health, NeedyMeds, and SingleCare, allow consumers compare prices and offer discounts on medications.

Since each of these programs works differently and drug costs vary, it is important to do your homework and read the fine print. Some discounts are not available to use with Medicare coverage. If you decide to use the discount instead of your coverage, your out-of-pocket costs will not count toward your Part D deductible (if you have one) nor to your plan’s out-of-pocket maximum.

See If You Qualify for Assistance

Several federal programs offer financial assistance to those who qualify, such as Medicare Savings Programs and Extra Help, as well as state programs, such as Medicaid and the Texas Rx Assistance Program. These programs reduce or eliminate the out-of-pocket costs associated with prescription medications for individuals with limited income and resources.

The experienced team at Healthcare Educators can show you all your options for prescription drug coverage and help you compare a variety of plans. Contact us today.