Saving Money on Prescription Drugs Not Covered by a Medicare Part D Plan

Quick summary

Most of us are painfully aware of the sky-high cost of prescription drugs. The person you're caring for may be one of the many people 65 and over who have enrolled in a Medicare Part D prescription drug plan to offset those costs. But most Part D drug plans don't cover any drug costs during the program's "doughnut hole" -- when the patient's total drug expenses for the year reach $2,700 (in 2009) but his out-of-pocket costs for the year haven't yet reached $4,350. Or he might not be enrolled in a Part D drug plan. In either case, you'll want to find ways to save money on out-of-pocket prescription drug costs. A number of sources for discounted prescription drugs are described here.

Could the person I'm caring for switch to a generic prescription drug?

He may be taking a brand-name prescription drug that has a generic equivalent. In virtually all cases, there's no difference whatsoever in the active ingredients between generic and brand-name drugs. If a generic is available, it usually costs far less than the brand name. He can check with his doctor or pharmacist to see whether a generic is available. The pharmacist can also tell him how much he would save by switching. If he has any doubts about whether the generic would work as well for him as the brand-name drug, he can ask his doctor.

Is there an equivalent prescription drug a patient could take?

Different companies within the pharmaceutical industry often produce virtually identical drugs under different brand names. One may be significantly cheaper than another. If a patient is taking a brand-name drug that has no generic equivalent, he can ask his doctor whether another company sells a nearly identical drug under a different name, then ask his pharmacist whether it's less expensive.

If there's no cheaper brand-name prescription drug with the same active ingredients, the doctor may know of a somewhat different drug also used to treat the same illness or condition. It may have come on the market after the person in your care began taking the other drug. Or maybe his doctor prescribed the other drug out of habit without considering an alternative. He can ask his pharmacist whether there's a significantly cheaper option to the drug he is taking. If so, he can check with his doctor whether it's a good idea to try it. He should ask whether the new drug is likely to be as effective as the one he's currently taking and what side effects it may have.

Are free sample of drugs available from his doctor?

Pharmaceutical companies constantly give doctors loads of free samples of the medications they sell. The reason is simple: They want the doctor to think of their prescription drugs when he's writing prescriptions. But they also want him to give away the samples to patients in the hope that the drug will be effective and the patient will continue to use it.

Doctors often give away a free drug sample to a patient who only needs one dose. Before the person in your care fills an expensive prescription, he should ask if his doctor has any samples. Doctors also frequently give a sample to a patient who's trying out a prescription drug for the first time. But there's no reason a doctor can't give away a number of free samples to the same patient. If a patient is without prescription drug coverage for a period of time -- for example, when he's within the Medicare Part D "doughnut hole" -- he may want to ask whether his doctor could provide him with samples to tide him over until his coverage kicks in again.

2. Getting financial help

Are there any state or local community assistance programs available?

Some states and local communities have programs to help older adults pay for a prescription drug when the drug or the patient isn't covered by a Medicare Part D plan or by Medicaid. Some of these programs offer discounts on all drugs, while others help only with certain common drugs. Often such programs limit their help to low-income, low-asset seniors. To qualify, a patient would need to provide evidence of his financial situation, which might include tax returns and bank, property, and investment statements.

Who's eligible for drug coverage under veterans' benefits?

If someone is a veteran, he may be eligible for free or low-cost medical care from the Department of Veterans Affairs (VA) healthcare providers. Different levels of VA coverage -- called "priority groups" -- are available to veterans with various types and eras of service, sources of medical condition, and financial status.

VA medical care can include free (for low-income veterans) or low-cost prescription drugs provided at a VA pharmacy. However, a VA doctor must prescribe these drugs. A veteran enrolled in Medicare is entitled to coverage for medical service from either the VA or Medicare but not both. So a patient who normally receives a prescription for a high-priced drug from a non-VA doctor would have to see a VA doctor to get the same prescription and have a VA pharmacy fill it at low or no cost.

To find out more about VA benefits, you can visit the Department of Veterans Affairs website. You can also call the general benefits phone service at 800-827-1000 or the health benefits service at 877-222-8387.

3. Discount drug programs

Is there a pharmaceutical company discount program for  prescription drugs?

Some pharmaceutical companies have programs to help low-income seniors by providing certain medications at reduced costs. The programs usually have strict income guidelines and offer only small discounts on certain medicines. Still, even small savings on an expensive medicine can add up if someone takes the drug regularly.

To get the reduced price, a patient must register directly with the pharmaceutical company's program. His doctor might also have to fill out papers required for enrollment in the program. And some programs provide the drug to the doctor, who then distributes it to the patient.

Are there any nonprofit or retail prescription drug discount programs a patient could join?

Some nonprofit organizations that cater to seniors or have large numbers of seniors in their membership have programs to help members get discounted prescription drugs. These include both national and state organizations, some connected to a particular professional, union, or fraternal group. There may be a membership fee, plus a co-payment for each prescription, and the total savings for any prescription is probably no more than 10 percent. But a 10 percent discount on an expensive medicine can be significant.

Many large pharmacy chains also set up programs to provide discounted prescription drugs for people with Medicare. These programs usually issue a membership card, which a person must present each time he buys a drug at one of the chain's stores.

4. Can someone get prescription drugs from Canada?

Hundreds of thousands of people in the United States buy prescription drugs online or by mail order, or travel to Canada from border states to fill their prescriptions. The total runs to billions of dollars a year. The reason? The Canadian healthcare system negotiates with the pharmaceutical companies for reduced prices. Anyone buying these drugs -- the same drugs that are sold in the United States for 50 to 80 percent more -- in Canada benefits from the discount. The law is murky on this subject; technically, U.S. Customs could seize such drugs, but in practice they almost never do.

To help the person in your care find a reliable Canadian source for prescription drugs, you need to take several steps. First find various options online by searching the Internet for "prescription drugs Canada." Then investigate any particular source by entering the name of the service in a search engine to look for reports of poor service or fraud. Check with any office of the nonprofit State Health Insurance Assistance Program (SHIP) or Health Insurance Counseling and Advocacy Program (HICAP) to vet the reputation of a Canadian pharmacy service that you're considering. You can find the number for a local office online or in the white pages of the phone directory under SHIP or HICAP. Finally, start small -- the first time, order only the smallest available amount of one medication. If that works out well, he can expand his orders to include other prescriptions or larger amounts.

5. How can I find prescription drug discount programs?

The Medicare website has a link called "Lower Your Costs During the Coverage Gap", which can direct you to several other links with information about state and local government and pharmaceutical company discount programs. You can get the same information by calling Medicare toll-free at 800-634-2273.

Free information on discount drugs is also available from the federal government's Area Agency on Aging, a clearinghouse for information about many issues concerning older adults. To contact it, go to the Area Agency on Aging website or call 800-677-1116.

Some online clearinghouses for drug discount information can also direct you to pharmaceutical company, retail, and other drug assistance programs. Among them are Pharmaceutical Research and Manufacturers of America, the Medicine Program, and Volunteers in Health Care.

Joseph L. Matthews

Joseph Matthews is an attorney and the author of numerous books, including Social Security, Medicare, and Government Pensions, Long-Term Care: How to Plan and Pay for It; How to Win Your Personal Injury Claim; and The Lawyer Who Blew up His Desk. See full bio