How to maximize your Medicare prescription drug benefit

Many members ask if they can use a prescription discount card with our drug list. The answer, in most cases, is no. The reason for this is due to the Anti-Kickback Statute. This statute prevents pharmaceutical companies from offering incentives or discounts when filling prescriptions when paid in part by a federal healthcare program, like Medicare. You can use a discount card or a drug coupon from a manufacturer or third-party company, like Good Rx, but you will not be able to combine that with your MAPD plan.  The total cost of the medication or your out-of-pocket costs would not be added to your Part D drug totals.

When it comes to getting the best price on your prescription drugs, it is always a good idea to shop the prices at different pharmacies. Every pharmacy prices prescriptions differently, and that price can vary with each medication. Pharmacy A might process one drug higher than pharmacy B, but with another drug, pharmacy B may price the drug higher than pharmacy A, and this could affect the total cost of the drug. You will still pay your set copayment, but this could effect when you reach the donut hole or coverage gap. In all cases, if the pharmacy charges less than what your Part D copay is set at, then you will pay the lower cost of the medication. For example, if your expected copay is $10, but the pharmacy only charges $4 for the medication, you will pay $4.

When possible, have the pharmacy fill your prescription using your Aspire benefit. Processing through Aspire allows your drug to be evaluated for drug interactions and other safety checks by comparing against the other drugs you have filled in the past. Aspire utilizes prescription drug claim history to help determine adherence. If you fill a medication that Medicare monitors for adherence, you may receive a phone call or a letter from us if you miss a refill. If you use a discount card outside of Aspire, we will not see that prescription refill in our system and may contact you to discuss your adherence and any challenges you might face in filling your prescriptions.

Drugs can be expensive and using generic alternatives is a great way to reduce your costs. Always ask your prescribing doctor if the prescription is on the Aspire drug list (formulary) and if there is a generic option for that drug.

If paying for your drugs becomes an issue, you may qualify for low-income subsidy (LIS) or there may be a lower tier available. We talk about how you can qualify for Extra Help for your Medicare prescription drug plan costs in a previous blog post.