Medicare specialist speaks on rising drug prices

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Prices for prescription drugs continue to increase, making it especially hard for seniors to afford their medications, and while some seniors on Medicare qualify for assistance, many aren’t aware that such help is available.  Medicare broker Joyce Seide spoke with Arizona Horizon as a part of our monthly AARP sponsored segment that highlights issues important to older adults in Arizona.

“Over the last 2 years, they’ve really gone out of sight, but a lot of the drug plans have tried to work on pushing more generic drugs, which is really helping,” Seide said. “But there are a lot of new drugs that are out there that are on higher tiers that cost a whole lot more and they haven’t come out with a generic alternative at this point. Those are the drugs that can really affect people.”

Of particular concern to those with Medicare coverage is the ‘donut hole,’ also known as the coverage gap. The coverage gap is a range of prescription drug expenses from $4430 to $6500 that aren’t fully covered by Medicare. Below that range the drugs are covered normally, above that range they are covered by ‘catastrophic coverage,’ but in between, patients can be stuck footing a large bill for pills.

“There are ways you can get around it, but once your cost reaches that level, then you’re responsible for 25% until your out-of-pocket costs reach $6500,” Seide said. One of those workarounds is to pay for cheaper, reduced-cost prescriptions out of pocket without turning them into insurance, thus keeping you from reaching the $4430 cutoff.

There are two major government programs that can help in this range: Medicaid and Extra Help. Medicaid is a state program for low-income individuals that covers the costs of many prescription drugs. Extra Help is a much less known federal program that provides reduced drug costs for those on Medicare, Medicaid, or with disabilities. You can apply for Extra Help here and for Arizona’s Medicaid program here.

Outside of these government programs, there are a few more things you can do to reduce what you spend on prescription drugs.

“The first thing I ask people is: ‘is there a generic that you can take that will cover you just as well of the higher tier drug?'” Seide said. “Also, go to your primary care physician and ask them if they have samples, or work with the manufacturer. A lot of times the manufacturer will have rebate programs that can help you with the cost of your drugs.”


Joyce Seide / Medicare specialist

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