Four Strategies for Reducing your Medicare Drug Costs

Why is the Cost of Medications so High?

Medications are a major out-of-pocket expense, especially for anyone with acute or chronic medical conditions. Unlike other countries with national health insurance systems, our Congress has supported the financial interests of Big Pharma and themselves and over interests of citizens to have access to affordable health care.

In return,Big Pharma has been a major source of more than $10 million a year in political contributions. In addition, they spend more on marketing to health care providers and  consumers than they spend on research and development of new medications to safely treat serious health conditions.

Medications that are critical to individuals’ health and well-being, are substantially more expensive in the US than in Canada, Europe and other countries.

Pharmaceutical companies are free to establish high prices for their government-protected patented drugs and this results in high consumer and government debt due to taxpayers subsidizing Big Pharma.

The US spending on pharmaceuticals is approximately $300 billion dollars a year. Political efforts to reform these  out-of-pocket expenses for medicare recipients have been very limited primarily to pharma companies agreeing to offer discounts to Medicare patients once they exhaust their initial Medicare coverage limits.

However, there are some strategies that consumers can use  to reduce and control their  medication expenses.

Strategies for Lowering Your Drug Costs

1. Know The Differences in Medication Cost and Coverage Before you a Select a Plan.

Medicare Advantage (MA) and stand-alone Prescription Drug Plans (PDP) are difficult to compare and can be very confusing for most people. However, not knowing the consequences of the plan that you select can be very costly.

Use Medicare’s Plan Finder at to compare the cost of medications among the different plans available in your service area. If you are changing insurance plans, don’t assume that the plan that you are considering includes the same medications and pharmacies.

Plans can often differ in their restrictions (eg. prior approval, quantity limit & step therapy) that they place on medications as well as the significant differences in Tiers and associated  co-pay/co-insurance that they establish for each medication.

Insurance companies and their pharmacy benefit managers (PBM) establish the plans detailed policies and procedures including:their drug formulary, medication restrictions, negotiated prices paid to pharmaceutical companies and pharmacies,  preferred medications and pharmacies, and the co-pays and co-insurances that consumers will pay.

2. Use your Plan’s Preferred and Mail Order Medications along with in-network, Preferred Pharmacies, Costco & Sam’s

Consumers can experience considerable savings by using your plan’s generic and preferred brand name meds whenever possible; making use of your plan’s mail order pharmacies for maintenance drugs and using your plan’s in-network and preferred pharmacies. And don’t forget to check with Costco and Sam’s. Many people don’t realize, you don’t have to be a club member to benefit from their low drug prices.

3. Check your Eligibility for Financial Assistance Programs.

If your income is low enough, your medical expenses are high enough or you meet other special criteria, you may be eligible for low or no cost medications.

Financial assistance can come from the federal (e.g.. Medicare’s Extra Help, Medicaid, Veteran’s Administration), state (State Pharmacy Assistance Programs such as NYS’s EPIC), private (Pharmaceutical Assistance Programs) or from specific clinical research programs.

4. Make Lifestyle Changes and Reduce Your Need for Medications

While you don’t have control of your genes, there are many things you can do for your health and reduce your risk of medical problems and need for medications.

Eating a healthy diet, exercising, getting adequate sleep, managing your stress, not smoking, limit your intake of alcohol, caffeine, sugar, salt, fat and processed foods will go a long way in reducing your risk of diabetes, cardiovascular diseases, hypertension, cancer and many other debilitating conditions can substantially reduce your quality of life and increase the need for costly medications.

When it comes to your health care, ‘buyer beware”.

Remember, no one has a greater interest in your health  or your pocketbook than you.

Feel free to share your comments and general questions.We all can learn from one another. Go to for more articles.


Jim Sorrentino

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