Medication Cost Reduction Tips

Medicare Part D

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Check the Formulary

There may be a different medication that will treat your condition that is in a lower tier which may cost you less every month. Show the formulary (link) to your doctor. Your doctor can help find the cheapest medication that is right for you: seniorpreferred.org/GundersenFormulary

Tier Exception Request

Medicare Part D plans may allow members to get a non-preferred drug at the better cost-sharing terms normally given to lower-tiered drugs within the same drug class. Submit a request with a supporting statement describing:

  • why the lower-tiered drug options would not be as effective as the requested drug
  • and / or that using them would likely cause adverse effects.

Aging and Disability Resource Center

The ADRC offers a benefits specialist and social workers who may help you answer medication coverage questions and concerns regarding ability to pay. Go to:  www.dhs.wisconsin.gov/adrc/consumer/index.htm (By clicking on this link, you will leave the Senior Preferred website.)
For Minnesota and Iowa, call (608) 785-5700 for resources available in that area.

Extra Help

A Medicare program helps those with limited income pay Medicare prescription drug program costs. This may include premiums, deductibles and coinsurance. For more information go to: www.socialsecurity.gov/prescriptionhelp (By clicking on this link, you will leave the Senior Preferred website.) or call (800) 772-1213. (TTY users call 1-800-325-0778). You may apply in person at the local Social Security office. Be sure to fill out the Extra Help application to find out if you qualify for other subsidy programs.

Social Worker

Your doctor’s office or healthcare center may have a social worker available. Social workers can help you navigate all of the options to save money, including the best ways to reduce your out-of-pocket costs.

Manufacturer’s Pharmaceutical Assistance Programs

This is not a copay card, but these are medications shipped free of charge from the manufacturer to you or your doctor’s office. The program is typically income-related. Go to: www.medicare.gov/pharmaceutical-assistance-program (By clicking on this link, you will leave the Senior Preferred website.)

State Pharmaceutical Assistance Programs (SPAPs)

Many states offer help paying drug plan premiums and / or other drug costs. For more information go to www.medicare.gov/pharmaceutical-assistance-program/state-programs.aspx (By clicking on this link, you will leave the Senior Preferred website.)

Rx Outreach

Provides prescription drugs to people who are uninsured and to people who have limited prescription drug coverage. It is a fully-licensed mail order pharmacy offering lower prices for more than 400 medications. Prescriptions are mailed to homes. There is an income limit to qualify. http://rxoutreach.org (By clicking on this link, you will leave the Senior Preferred website.)

Drug Repository Program

Participating pharmacies can accept donated, unused, sealed medications. These can then be dispensed by a pharmacist to other patients for a minimal charge. Find a participating pharmacy: www.dhs.wisconsin.gov/guide/cancer-drugrepo.htm (By clicking on this link, you will leave the Senior Preferred website.)


**See Below: Medicare Part D: Coverage Stages

Medicare With No Drug Coverage

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Aging and Disability Resource Center

The ADRC offers a benefits specialist and social workers who may help you answer medication coverage questions and concerns regarding ability to pay. Go to: www.dhs.wisconsin.gov/adrc/consumer/index.htm (By clicking on this link, you will leave the Senior Preferred website.)

For Minnesota and Iowa, call (608) 785-5700 for resources available in that area.

Extra Help First, Then Explore Wisconsin Senior Care

A Medicare program helps those with limited income pay Medicare prescription drug program costs. This may include premiums, deductibles and coinsurance. For more information go to: www.socialsecurity.gov/prescriptionhelp (By clicking on this link, you will leave the Senior Preferred website.) or call (800) 772-1213. (TTY users call 1-800-325-0778). You may apply in person at the local Social Security office. Be sure to fill out the Extra Help application to find out if you qualify for other subsidy programs.

Wisconsin Senior Care – Must be a Wisconsin resident and 65 or older. Program is similar to Badger Care (same drug formulary)

GHS Clinic Pharmacy Cash Card Program

Available at GHS Clinic pharmacies in La Crosse or Onalaska if you have medications prescribed by a Gundersen doctor. This program may reduce the cost you pay for medications. It includes all brand and generic drugs. The program is provided at no cost to you and there are no income restrictions. Note: this is only available to patients without prescription insurance.

Social Worker

Your doctor’s office or healthcare center may have a social worker available. Social workers can help you navigate all of the options to save money, including the best ways to reduce your out-of-pocket costs.

Manufacturer’s Pharmaceutical Assistance Programs

This is not a copay card, but these are medications shipped free of charge from the manufacturer to you or your doctor’s office. The program is typically income-related. Go to: www.medicare.gov/pharmaceutical-assistance-program (By clicking on this link, you will leave the Senior Preferred website.)

State Pharmaceutical Assistance Programs (SPAPs)

Many states offer help paying drug plan premiums and / or other drug costs. For more information go to www.medicare.gov/pharmaceutical-assistance-program/state-programs.aspx (By clicking on this link, you will leave the Senior Preferred website.)

RxOutreach

Provides prescription drugs to people who are uninsured and to people who have limited prescription drug coverage. It is a fully-licensed mail order pharmacy offering lower prices for more than 400 medications. Prescriptions are mailed to homes. There is an income limit to qualify. http://rxoutreach.org (By clicking on this link, you will leave the Senior Preferred website.)

Drug Repository Program

Participating pharmacies can accept donated, unused, sealed medications. These can then be dispensed by a pharmacist to other patients for a minimal charge. Find a participating pharmacy: www.dhs.wisconsin.gov/guide/cancer-drugrepo.htm (By clicking on this link, you will leave the Senior Preferred website.)


Additional Resources

  1. Benefits checkup is a website run by the National Council on Aging. Using this site, you can see if you are eligible for assistance related to medication or health care costs, income assistance, food and nutrition, housing and utilities, employment and volunteering, transportation and more: www.benefitscheckup.org (By clicking on this link, you will leave the Senior Preferred website.)

  2. Partnership for Prescription Assistance is a website with an application that can determine your eligibility for medication assistance: www.pparx.org (By clicking on this link, you will leave the Senior Preferred website.)

  3. Great Rivers 211 a local resource that can connect you to community resources for medications and any other assistance: https://211wisconsin.communityos.org (By clicking on this link, you will leave the Senior Preferred website.)

Helpful Tips

  1. Combination Pills: If you are on two different medications that treat the same condition, sometimes there is a combination pill that includes both medications in the same pill. This may help to reduce the number of pills you take per day and reduce the number of copays you are paying.  Common examples include medications for blood pressure (lisinopril/hydrochlorothiazide, etc.) and diabetes (glipizide/metformin, Synjardy XR (Jardiance/metformin ER), Glyxambi (Jardiance/Tradjenta), etc).

  2. Consider Mail Order: Medications may cost less when filled for a three month supply through mail order.  Refer to your mail order benefit for additional information.

  3. Compare Prices Among Pharmacies: Use the pharmacy pricing tool (www.seniorpreferred.org/RxLogin) to compare what your medications would cost at different pharmacies.  Pharmacies may have different contracted rates with the Pharmacy Benefit Manager (PBM) which your insurance uses. This is especially relevant in the Coverage Gap (Stage 3).
    
This web page was updated on November 7, 2017.