Medicare Prescription Drug Prices

As a Medicare beneficiary, you may have heard a lot about Medicare prescription drugs prices. However, the actual cost of drugs with a Medicare plan can be complicated, with several factors determining what you pay each year. Here’s what you need to know:

1. Premiums: If you have a stand-alone prescription drug plan, you’ll pay a premium that varies depending on the carrier and plan coverage you choose. The cost can be as low as $7 or as high as $100, depending on your needs.

2. Deductibles: Most plans have an annual deductible for certain medications, depending on the medication’s tier on the plan’s formulary. In 2023, PDPs cannot exceed an annual deductible of $505.

3. Copayments and Coinsurance: These are the amounts you pay for covered drugs once you’ve met your plan’s deductible. The amount you pay depends on the tier level assigned to your medication.

4. Coverage Gap: Once you and your drug plan spend a specified total amount of money for your prescriptions ($4,660 in 2023), you reach the coverage gap. People with Medicare who get Extra Help paying Part D costs do not fall into the coverage gap.

Other factors that affect the cost of your Medicare prescription drug prices include:

1. Extra Help: Medicare provides “Extra Help” to individuals who have limited income and resources. This program helps pay for Medicare Part D costs, including premiums, deductibles, and coinsurance, as well as other costs.

2. Late Enrollment Penalty: If you don’t enroll in Medicare Part D when you’re first eligible, you may have to pay a penalty added to your Medicare prescription drug plan premium.

3. Monthly Premium: Each prescription drug plan has its monthly premium that varies by carrier and plan offered.

Remember, the cost of Part D covered insulin drugs is now capped at $35 for a one-month supply, and a deductible does not apply to this amount. If you receive a 60 or 90-day supply of insulin, the price cannot exceed $35 for each month’s supply.

If you find that the cost of a particular prescription is higher than you anticipated, talk to your doctor about lower cost alternatives, or check with your prescription drug plan provider to see if they cover alternative drugs at a better rate. You can also visit the cms.gov website to learn more about drug prices.

BOOK NOW!