Question: My part D plan doesn’t cover one of my medications. Can I just pay for it with cash?

Answer: I often have individuals tell me this time of year that next year one of their medications are not covered by their plan. Is it possible to keep their coverage and get this medication another way. Sometimes medications that are covered can be cheaper for cash than their insurance coverage price even when it is covered by their plan. Remember than your insurance company is negotiating that cost with the pharmacy and the pharmaceutical company. Sometimes those prices seem to be inflated and then they discount the cost to your copay structure. The Part D plans also change their formularies every year. Each year there seems to be one or two generic medications that seem to fall out of favor and become more expensive.

Companies like “GoodRx” and CostPlusDrugs are medication discount opportunities you can use. We regularly talk with clients about GoodRx and CostPlusDrugs.

First, let me clarify, if you are eligible for Medicare and enrolled in Medicare Part A or Part B or both, there is a law that requires you have Prescription Drug Coverage. There is a “minimum standard plan” that your Prescription Drug Coverage Insurance must meet (creditable coverage). If you don’t have that “Minimum Standard Prescription Drug Coverage”, there is a penalty for the months you don’t have that Prescription Drug Coverage, if you decide to enroll later.

When you have Medicare or are eligible for Medicare, you should have some sort of Prescription Drug Plan (insurance for your medications).

You have this open enrollment period to find the best possible prescription drug coverage for them, evaluating options based on pharmacy, medications you take, and your other healthcare needs. The www.medicare.gov website has a very useful tool to do this.

During the evaluation process, you often find that the same medications at the same pharmacy can have vastly different prices, based on the insurance product you are reviewing. You can also find that by switching to an alternative pharmacy, you may be able to save money on the cost of the medications.

Please understand, GoodRx and CostPlusDrugs are NOT insurance. The business works on finding you the best possible price for your medications and can be used by anyone, anywhere.

GoodRx can be used with a card you carry in your wallet, or you can print off coupons from your computer, or using your smartphone to ‘show’ the coupon to the pharmacy to get your savings.

CostPlusDrugs is an internet based mail order pharmacy company that allows your physician to prescribe your medications much like your usual mail order pharmacy. You must create a login and establish a payment method to get your medications on the website (www.costplusdrugs.com). You can use this website to order your medications as long as your physician has prescribed them, much like they would a local pharmacy. These medications are usually very low priced and sometimes could cost less than your insurance coverage prices them.

Both of these services apply to only generic medication, and may not be useful for all the medications you are currently taking.

Remember when you have health insurance that covers your prescription drugs, you can only use one source to fill each medication, your insurance or GoodRx or CostPlusDrugs. You can’t use multiple services to fill the same medication. You can use each of these to cover some of your medications and other medications use other coverage.

Your pharmacy can tell you what price your known insurance coverage is charging you for medication and even print you out a history of what you paid over the last year. You can compare that to GoodRx and CostPlusDrugs price and then choose which one makes the most sense. If you switch to the GoodRx price, realize that your physician must prescribe it to the correct pharmacy or mail order service. If using the local pharmacy, the cashier/pharmacist must pull it out of your insurance and then re-ring it up using the GoodRx coupon. This will take some time.

When you choose the GoodRx or CostPlusDrugs coverage, it means your prescription co-pays are not going through your Prescription Drug Coverage phases of coverage. Your co-pays are not being processed by your EPIC coverage, if you are eligible for EPIC.

I do recommend looking up these alternative options pricing before you are standing in line at the pharmacy. You need to be aware of what these other services can do for you, but you should not stand at the register trying to figure all this out, while other customers line up behind you.

GoodRx and CostPlusDrugs will not work for brand name medication and controlled substances.

GoodRx has telephone support if you have questions, (855) 268-2822 (Monday-Sunday, between the hours of 8am and 7pm CT). CostPlusDrugs.com is an internet company and all questions or concerns run through their website.

If you have Medicare you have a requirement to be enrolled in an approved (creditable) Prescription Drug Plan. If you choose to not have a creditable drug plan, you are accruing a penalty for every month you are without Prescription Drug Coverage. GoodRx and CostPlusDrugs are NOT insurance.

I would recommend that you enroll in a Medicare approved Prescription Drug Plan. Then in addition, review the pricing of GoodRx and CostPlusDrugs as tools that can save as much as possible on your medications.

To contact Janell Sluga, GCMC with insurance questions or concerns, please call 716-720-9797 or e-mail her at janells@lutheran-jamestown.org.