Just Ask!!

A simple question at the pharmacy could unlock savings for millions of Medicare beneficiaries.

Under a little-known Medicare rule, they can pay a lower cash price for prescriptions instead of using their insurance and doling out the amount the policy requires. But only if they ask.

That doesn’t mean people with Medicare drug coverage are destined to overpay for prescriptions. They can get the lower price, when it’s available, simply by asking, says Julie Carter, federal policy associate at the Medicare Rights Center, a patient advocacy group.

“If they bring it up, then we can inform them of those prices,” says Nick Newman, a pharmacist and the manager at Essentra Pharmacy in rural Marengo, Ohio. “It’s a moral dilemma for the pharmacist, knowing what would be best for the patient but not being able to help them and hoping they will ask you about the comparison.”

For consumers inclined to price-shop, details may be hard to find: Medicare’s website and annual handbook don’t mention it.

And many beneficiaries may not know that if they pay a lower cash price for a covered drug at a pharmacy that participates in their insurance plan and then submit the proper documentation, insurers must count it toward their out-of-pocket expenses. The total of those expenses can trigger the drug coverage gap, also known as the donut hole. (This year, the gap begins after the plan and beneficiary spend $3,750 and ends once the beneficiary has spent a total of $5,000.)

[excerpts are taken from NPR’s Susan Jaffee reporting on Medicare prescription drug costs]