Prescription Cost Tips - A New Landscape

There have been a lot of changes to Medicare prescription coverage since the inflation reduction act was signed in August 2022.  The Part D prescription out-of-pocket maximum is capped at $2,100.00 in 2026.  You used to have to spend $8,000/year and even then you would still face a copayment.  For the out-of-pocket limit to apply the drug must be a covered drug under your Part D plan.

If the drug you need isn't on the plan's formulary (drug list) you can shop plans every year during the annual election period between October 15th and December 7th to find the plan that does the best job covering your drugs.  We help people do this using medicare.gov. 

Under the rules, every plan must cover at least 2 drugs in every class of drugs.  This means that even if your drug isn't covered there should be at least two that are covered.

Your doctor also has a process that can get non-formulary drugs covered if the approved drugs don't do the job. 

With a new prescription, if the drug isn't covered, your plan may still give you a transition fill.  This is a 30 day supply to allow you to discuss options with your doctor.

You can buy your drugs yourself - but the amount you spend will not count towards the annual out-of-pocket maximum.  Sometimes this is a better choice, especially when the Medicare price is substantially higher than the price through one of the discount pharmacies.
We can help you find the lowest cost pharmacy whether it is local or mail order.