Seniors and caregivers are in the habit of using insurance benefits to pay for prescription medication. But sometimes, the cash price could actually be cheaper. FamilyWize explains how new laws will allow pharmacists to share the best price option and how asking a few simple questions saves seniors money on prescriptions.
Did you know that seniors could save money by paying cash for their prescription medications?
If your older adult’s health insurance covers prescription drugs, they most likely always use their insurance benefits when buying medication. But that might not be the lowest price.
Due to restrictive contracts between pharmacies and insurance plan providers, pharmacists haven’t been able to point out when a patient could save money by paying the pharmacy’s lower cash price rather than the price negotiated by their insurance plan.
The good news is that, in the future, these so-called “gag order” clauses will become illegal.
Find out how new laws help seniors save money on prescriptions, what questions to ask pharmacists to find the lowest price, and why shopping around results in a lower prescription price.
New laws allow pharmacists to help patients find lower prices
On October 10, 2018, the Know the Lowest Price Act and the Patient Right to Know Drug Prices Act were signed into law.
These new laws ban Medicare Advantage plan providers, providers of Medicare Part D prescription drug plans, and commercial health plans from including “gag orders” in their contracts with pharmacies.
That means that after the laws go into effect on January 1, 2020, pharmacies will always be able to let patients know when they can provide a lower price than insurance.
Even though pharmacists will no longer be banned from discussing lower price options with their patients, they also won’t be required to disclose cash options.
That’s why it is so important for seniors and caregivers to feel comfortable asking questions at the pharmacy counter in order to get the lowest prescription drug prices.
How to ask pharmacists for the lowest prescription prices
It’s a good habit to always ask about the lowest price at the pharmacy counter. In generally, this information is quick for pharmacy staff to look up.
To get the best information, especially if pharmacy staff are busy, try to be as specific as possible.
You might want to ask:
- What will it cost if we choose NOT to use our insurance?
- Do you offer a lower cash price for this prescription?
- Do you have any suggestions for saving money on [specific drug name]?
Prescription pricing is inconsistent; save money by shopping around
Often, an insurance copay will be the cheapest option for your older adult’s prescription medication.
In other situations, getting the lowest price may mean paying cash for the prescription rather than using insurance.
Sometimes, pharmaceutical manufacturers’ coupons or prescription discount cards may be the best choice for saving money with or without insurance coverage.
It’s also important to remember that not all pharmacies charge the same price for the same prescription drug.
Even though an insurance copay will likely stay the same no matter where you use it, the retail price of a drug may change depending on the pharmacy your senior uses.
For example, some big box retailers have negotiated very low cash prices for popular generic blood pressure drugs, blood thinners, and cholesterol medications.
If your older adult takes a commonly prescribed maintenance medication (a treatment that will continue indefinitely), it pays to compare prices at local pharmacies and big box retailers to find the lowest price.
Expect even more prescription price transparency
In the future, federal officials are debating forcing pharmaceutical companies to disclose list prices of prescription drugs in their television advertising, increasing transparency in the industry.
The New York Times reports that some people compare the proposed regulations to sticker price requirements for automakers.
All of this is a great reminder that there are many different ways for seniors to afford their medications, whether they use their health insurance or not.
Recommended for you:
- 7 Ways for Seniors to Reduce Prescription Drug Costs
- 5 Ways to Afford Prescriptions in the Medicare Donut Hole
- 14 Questions to Ask Doctors When Starting New Medications for Seniors
Guest contributor: Ken Majkowski, Pharm.D, is the Chief Pharmacy Officer at FamilyWize, an organization that provides a free prescription discount card and mobile Rx app to help people better afford their medications, regardless of insurance coverage. Ken brings more than 40 years of healthcare experience to the FamilyWize team, including 14 years of clinical pharmacy experience in retail, hospital, and home care.
Image: GreenLight Pharmacy
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Barbara Shore
I’m in a Medicare Advantage plan (awesome!) so drug coverage is part of my plan. Of course, there are restrictions on which drugs the plan covers and doesn’t. Not a problem for me, I know generics are the most cost effective, when available. And even so, plans don’t always cover all generics.
When price comparing my Rx, the Costo pharmacist helpfully pointed out that they could fill a 180 or 360 day rx for the same price as a 90 day. Which turned out to be cheaper than running the rx through insurance. My doc was willing to write the rx for 360, since I’d been on the same generic for years without issue. I fill the rx for a year at a very reasonable cash price, and get reimbursed from my retiree HRA that my former employer provides. No mail order refills to remember, no multiple trips to the pharmacy, sometimes easier and cheaper to pay cash for a larger quantity rx if that works for you. But check your pricing both ways, because things can change.
DailyCaring
It’s wonderful that you’re happy with your health insurance plan! And fantastic that you’ve been able to get such a great deal on your prescription medication and the added convenience of only picking up a prescription once a year! Speaking with the pharmacist about the options available and working with your doctor to get the necessary prescription was well worth it for you 🙂 Thank you for sharing your experience.