Prescription Coupons

[tvguy]

Always check a drug makers website for coupons.
Since going on Medicare 3 years ago I have started taking some crazy expensive medicines.
I have private Part D Prescription coverage and before I hit my annual cap, my blood thinner would have been over $700. After I hit my cap, it would have dropped to $115 due to the "tier" drug it is. But with a coupon it is $30. All prices are for a 90 day supply.

 

[Dan Murphy]

GoodRx and other similar apps/sites are great also.

 

[tvguy]

GoodRx and other similar apps/sites are great also.

You have to be careful with GoodRX and similar discount programs. I went on a new medicine in January that is expensive and GoodRX was $100 cheaper, HOWEVER my insurance does not count what I paid on the GoodRX purchase against my annual cap. With GoodRX that prescription would be $900 out of pocket for a 3 month supply, or $2,700 for the year. Paying the full $1000 price for a 3 month supply, all the $1000 goes against my cap, so if that were the only prescription I paid for, my maximum out of pocket would be $2,000, my cap. So the third refill on per year would be free. So you have to do the math for the entire year, not just one refill.

 

[Lewisc]

Sometimes an alternative drug may be significantly less expensive. The alternative drug might be as good, or almost as good. Check your formulary, ask your pharmacist or call your insurance. Ask your doctor about options.

 

[tvguy]

Sometimes an alternative drug may be significantly less expensive. The alternative drug might be as good, or almost as good. Check your formulary, ask your pharmacist or call your insurance. Ask your doctor about options.

Certainly a question worth asking. Unfortunately for me, two of my most expensive prescriptions, the alternative drug is just as expensive for more expensive. And one have been around for decades and my Doctor says, no drug maker has expressed any interest in making a generic version.

 

[atthebeachclub]

Always check a drug makers website for coupons.
Since going on Medicare 3 years ago I have started taking some crazy expensive medicines.
I have private Part D Prescription coverage and before I hit my annual cap, my blood thinner would have been over $700. After I hit my cap, it would have dropped to $115 due to the "tier" drug it is. But with a coupon it is $30. All prices are for a 90 day supply.

You have to be very careful with this; read the terms and conditions closely. Part D patients (among other patients covered through government programs) are unfortunately not legally eligible to use many/most coupons with their plan because of anti kickback statutes. https://www.medicalnewstoday.com/articles/drug-coupons-and-medicare

 

[Lewisc]

I have private Part D Prescription coverage and before I hit my annual cap, my blood thinner would have been over $700. After I hit my cap, it would have dropped to $115 due to the "tier" drug it is.

That's 2024 and earlier.
2025 all plans have a $2000 out of pocket maximum INCLUDING your deductible.
Once you hit the maximum your cost drops TO ZERO for covered drugs.

My eye drops are over $300 with insurance vs $79 with a coupon. Then $79 doesn't count against the cap and PREVENTS you from changing to insurance during the year

EDITED
I NOTE YOU CLARIFIED THIS IN A SUBSEQUENT POST. I'm not going to delete it. The information is important.

 

[atthebeachclub]

That's 2024 and earlier.
2025 all plans have a $2000 out of pocket maximum INCLUDING your deductible.
Once you hit the maximum your cost drops TO ZERO for covered drugs.

My eye drops are over $300 with insurance vs $79 with a coupon. Then $79 doesn't count against the cap and PREVENTS you from changing to insurance during the year

I sometimes don’t think patients realize what a monumental change this is for Part D. It is huge, and decreases seniors’ financial risk substantially. It is really a great thing for retirees, if only more of them realized it was a great new change benefitting them.

 

[tvguy]

You have to be very careful with this; read the terms and conditions closely. Part D patients (among other patients covered through government programs) are unfortunately not legally eligible to use many/most coupons with their plan because of anti kickback statutes. https://www.medicalnewstoday.com/articles/drug-coupons-and-medicare

Mine Part D is private insurance, but good point.

 

[atthebeachclub]

Mine Part D is private insurance, but good point.

Private or not, you have the same restrictions if it is a Part D plan. It isn’t a commercial plan (commercial plans mean through a workplace for example).

 

[tvguy]

Private or not, you have the same restrictions if it is a Part D plan. It isn’t a commercial plan (commercial plans mean through a workplace for example).

Nope. I have Wellcare and entered all my information and the manufacturer site said I was qualified. That was two years ago , it was good for two years, and it allowed me to renew it yesterday.

 

[atthebeachclub]

Nope. I have Wellcare and entered all my information and the manufacturer site said I was qualified. That was two years ago , it was good for two years, and it allowed me to renew it yesterday.

In my professional opinion you should ask your pharmacist (not the technician) and call the manufacturer stating you have a WellCare Part D plan and are ensuring your eligibility for manufacturer coupons to get the information straight from them. This is my field of expertise but I defer to those working directly with you.

 

[Lewisc]

Mine Part D is private insurance, but good point.

Nope. I have Wellcare and entered all my information and the manufacturer site said I was qualified. That was two years ago , it was good for two years, and it allowed me to renew it yesterday.

Medicare D is considered government insurance, provided under contact by a private insurer.

Some coupons can only be used if the drug isn't covered by your formulary.

Other coupons give you the option of insurance or using the coupon.

The amount you pay using the coupon doesn't count against your $2000 maximum. You're generally not allowed to switch and use your insurances for future fills, same calendar year.

Insureds with at least 2 expensive drugs should almost always skip the coupon. If the math is close skip the coupon, you don't know what you'll be taking layering the years

The analysis changed dramatically in 2025

 

[Lewisc]

In my professional opinion you should ask your pharmacist (not the technician) and call the manufacturer stating you have a WellCare Part D plan and are ensuring your eligibility for manufacturer coupons to get the information straight from them. This is my field of expertise but I defer to those working directly with you.

Last year I used coupons for 3 different drugs. The mfg had a different coupon for Medicare patients. I'll edit this post with a link.

Some coupons only work if your formulary excludes the drug.

An example
https://harrowconnects.com/

 

[atthebeachclub]

Last year I used coupons for 3 different drugs. The mfg had a different coupon for Medicare patients. I'll edit this post with a link.

Some coupons only work if your formulary excludes the drug.

Yes, if we are not running insurance because your insurance doesn’t cover an item, a coupon may be used in place of insurance to reduce out of pocket costs. There are rare instances such as Paxlovid where there is a special Part D affordability option from the manufacturer via the US government, and Eliquis has a free trial coupon Part D patients may use (without their insurance). Some of the newer weight loss injectables tend not to be covered under Part D and patients may use a coupon instead of insurance to reduce cash price. The big thing is: these are not stackable with your Part D insurance.

The tricky part is when your plan covers a medication and the patient tries to add a coupon ON TOP of their Part D coverage. That is a no go. You certainly can get a manufacturer website to spit out a coupon for you if you inadvertently give incorrect information (easy to do), and it will generally run through automatically at the pharmacy if someone isn’t paying attention. BUT is also illegal and something pharmacies are required to watch for.

I really love that you know your plan and understand how to use it so well; that is quite uncommon.

 

[tvguy]

In my professional opinion you should ask your pharmacist (not the technician) and call the manufacturer stating you have a WellCare Part D plan and are ensuring your eligibility for manufacturer coupons to get the information straight from them. This is my field of expertise but I defer to those working directly with you.

I agree. Did this all yesterday.

 

[Dan Murphy]

You have to be careful with GoodRX and similar discount programs. I went on a new medicine in January that is expensive and GoodRX was $100 cheaper, HOWEVER my insurance does not count what I paid on the GoodRX purchase against my annual cap. With GoodRX that prescription would be $900 out of pocket for a 3 month supply, or $2,700 for the year. Paying the full $1000 price for a 3 month supply, all the $1000 goes against my cap, so if that were the only prescription I paid for, my maximum out of pocket would be $2,000, my cap. So the third refill on per year would be free. So you have to do the math for the entire year, not just one refill.

Absolutely, always do the math with the several ways a drug can be purchased.

 

[kanerf]

Picked up my 90 day prescription the other day for my COPD inhaler and the price with insurance was $75. With the manufacturers coupon it was $0.