Q&A: Helping Medicare patients afford prescriptions

Q: How can case managers help Medicare patients who may not be able to afford their prescriptions?

A: CMS provides some recommendations for lowering medication costs and/or covering gaps, including:

• Consider switching to generics or other lower-cost drugs. Talk to your doctor to find out if there are generic or less expensive brand-name drugs that would work just as well as the ones you’re taking now. You might also be able to save money by using mail-order pharmacies.
• Choose a plan that offers additional coverage during the gap. There are plans that offer additional coverage during the coverage gap (Medicare prescription drug coverage), like for generic drugs. However, plans with additional gap coverage may charge a higher monthly premium. Check with the drug plan first to see if your drugs would be covered during the gap.
• Pharmaceutical Assistance Programs. Some pharmaceutical companies offer help for people enrolled in Medicare Part D. Find out whether there’s a Pharmaceutical Assistance Program for the drugs you take.
• State pharmaceutical assistance programs. Many states and the U.S. Virgin Islands offer help paying drug plan premiums and/or other drug costs. Find out if your state has a State Pharmaceutical Assistance Program.
• Apply for extra help. Medicare and Social Security have a program for people with limited income and resources that helps you pay for your prescription drugs. If you qualify, you could pay no more than $3.40 for each generic or $8.50 for each brand-name covered drug.

For more information, see the HCPro book, Care Transitions in Case Management.

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