Southern Senior Care Blog

Based on our research and your feedback, the majority of U.S. citizens believe that the Medicare Part D “Drug Plan” has worked well and did reduce out-of-pocket costs for prescription medicines in 2006 and 2007. Even so, we have spoken with a few clients whose experiences were not so positive.

This month’s main story will focus on a number of cost cutting strategies which could help you save money on your prescription drugs. We’ll start off with some simple, straightforward methods and finish with a few lesser known strategies.

I. Plain ‘Ol Generics

The first line of defense in cutting prescription costs is to use lower “Tier” drugs (i.e. generics). Most Part-D plans divide drugs into three Tiers. Tier-1 is made up of mostly generic drugs. The co-pay on Tier-1 drugs is usually $0-$7. The next level is Tier-2. The co-pay on Tier-2 drugs is usually around $20. The most expensive drugs are Tier-3. The co-pay for Tier-3 drugs is typically around $60. So, if you can get a generic replacement for a Tier-3 drug, you would save about $55/month or $660/year. If you are taking any Tier-3 drugs, it is definitely worth the time to check with your doctor or pharmacist to see if you can switch to a generic version..

II. Breaking up is Hard to Do

Q: Why do most pills have those little grooves in them?

A: So you can cut your costs, er pills, in half.

See if your doctor will write you a prescription for double dosage (ex. Instead of 10mg, get 20mg) and cut them in two. Your thirty-day supply is now a sixty-day supply, and you’ve cut your costs in half.

We have been told that this is getting harder to do, but it’s still worth trying.

III. Doctors Samples

Another way to save money is by using samples. This is especially helpful if you have to try a new brand name drug and don’t know if it will work. Pharmaceutical companies provide most doctors with samples of new medicines, the ones that aren’t available in generic form yet. Ask your doctor if he/she can get you some samples. If they do not work for you, you haven’t wasted a $60 tier-3 co-pay. And, just as importantly, you haven’t added an expensive tier-3 retail price to your annual prescription costs, which determines when you enter the “Donut Hole.” Now is a good time to explain just what this donut hole is all about.

What is the Donut Hole?

All Part-D plans include something called the Donut Hole - a cute name for something not-so-cute. Starting on January 1^st of each year, the total cost of your prescriptions is added up. When this total reaches $2,510, most plans stop paying their part of the costs. You pay 100% of your prescription costs, until your total out of pocket expenses reach $4,050, at which time the plan starts paying again.

For example, if your prescriptions cost $600/month (not your co-pay, but the actual cost of your prescriptions), you would enter the donut hole at the beginning of May. The cost of your drugs will have reached $2,400 at this time ($600/month for four months - Jan, Feb, Mar, Apr - which is $2,400.

Your total out-of-pocket costs (TOOP) at this point is probably a few hundred dollars - whatever your co-pays have been. You now have to pay the full $600/month until your TOOP costs reach $4,050. At $600/month, your TOOP will reach $4,050 around December. Which means you will be getting out of the Donut Hole right at the end of the year. And everything starts over at $0 again January 1^st.

There are three typical scenarios:

1. Your total prescription costs are less than $200/month, and you never enter the Donut hole.

2. Your total prescription costs are between $200 and $600/month, in which case you will certainly enter the donut hole, but chances are, you won’t get out before the end of the year because your TOOP costs will not exceed $4,050.

3. Your total prescription costs are over $600/month, in which case you will definitely enter the donut hole, and probably exit the donut hole. Exactly when you exit depends on your total monthly prescription costs.

If you are in category 1, that is great. Stay as healthy as you can, and do your best to stay on inexpensive (i.e. generic) prescription drugs.

If you are in category 2, then use all of the strategies in this newsletter to reduce the cost of your prescriptions. Try to enter the donut hole as late in the year as possible.

If you are in category 3, you should try to reduce the costs of your prescriptions using the previous methods, but it might not be possible. You may have to use brand-name prescriptions.

If you are in category 2 or 3, you may want to consider getting some of your more expensive prescriptions via mail-order from our neighbors north of the border.

IV. Oh Canada

Before we get into details on how to order your prescriptions from Canada, let me give you a little background information.

According to the Associated Press, on October 4, 2006 an email was sent from the Department of Homeland Security to congressional staff explaining a change in policy. An excerpt is included below.

Associated Press - October 4, 2006 - By Stephen Majors

U.S. Customs and Border Protection will stop seizing prescription medications mailed from Canada for personal use in small amounts, Sen. Bill Nelson said Tuesday.

Since Nov. 2005, authorities have seized the prescription drug shipments of 40,000 Americans who bought prescriptions from Canada, where prices are lower, Nelson said.

The new policy goes into effect on Oct. 9. It was announced in an e-mail from the Department of Homeland Security sent Monday to congressional staff, Nelson said.

In plain language, this means that you can now get your prescriptions filled through Canadian pharmacies and mailed directly to your home. The process is fairly straight forward and many people are reporting savings of up to 50% over the costs of having their prescriptions filled here in the U.S.

Prescription drugs are significantly cheaper in Canada because its national health-care system negotiates lower prices for its citizens.  The U.S., by contrast, is one of the only markets in the world where the government doesn’t exercise control over drug prices. One couple we talked to said they paid $624.77 for a three-month supply of drugs at an online Vancouver registered pharmacy. These same drugs cost them $1,208.04 at Walgreen’s, Target, and Kmart.

A number of our clients have spoken to us about their positive experiences ordering prescriptions from Canada. If you decide to try it out, let us know how it works out for you.

The two Canadian Pharmacies listed below seem to be the most popular.

1. Canada Drugs - Phone: 1-866.444.3784;
Website: http://www.canadadrugs.com/

2. Canada Pharmacy  - Phone: 1-800.891.0844;
Website: http://www.canadapharmacy.com/

For an extensive list of Canadian Pharmacies visit the following website: http://www.suddenlysenior.com/canadiandrugstores.html