Medicare and rising prescription drug costs

Know your prescription cost and options

As a soon-to-be or current Medicare beneficiary, you may be concerned with the cost of your prescription medications. Carefully managing your out-of-pocket costs is vital, especially if you’re taking multiple prescription medications and want to ensure that you can continue paying for them throughout the year – including during the coverage gap period associated with Medicare Part D plans (when your drug benefit coverage has reached its limit for the Initial Coverage period and before you are eligible for “catastrophic coverage”). Understanding your total health care costs, including what you pay for your prescription medications, can help you take an active role in your health care decisions which can lead to better health outcomes.

The passing of the Inflation Reduction Act of 2022 has, among other things, introduced reforms that will help lower prescription medication prices. For seniors taking multiple medications, this can be life changing; the skyrocketing cost of medications led to many people not picking up their medications from the pharmacy – or even splitting their doses in half to avoid running out of their medications.¹ Not taking routine medications or the proper dosage of a prescribed medication can result in health conditions not being properly managed, which can lead to more doctor visits or a hospital stay.
 

Become a more informed health care consumer

Understanding your medication costs is an important part of taking a more active role in your health care decisions, but there’s more to consider. Both the Hospital Price Transparency law (effective January 1, 2021) and Health Plan Price Transparency law (effective July 1, 2022) make it easier for seniors to know what their health care services cost in order to avoid surprises when the bills arrive. Cost transparency allows you to estimate your costs and to compare prices before you receive services, such as a knee replacement, or a medication infusion at a hospital or outpatient infusion center, so that you can plan financially and make more informed decisions with your doctor.
 

Another tool at your fingertips

As part of Blue Shield’s commitment to cost transparency, starting January 1, 2023, you will have access to a better tool that provides personalized real-time information about your medication costs, lower cost options and coverage. 

When you log in to your Blue Shield account on your computer and go to the Pharmacy page, or you log in to the Blue Shield app on your smart phone, you can choose to price check your current prescriptions and:

1. See your active prescriptions and their current costs.
2. See lower-cost alternative options (generic and brand alternatives) and potential savings specific to you (if available).
3. See how much you would pay if you filled your prescription at a different pharmacy.
4. Estimate prescription costs to see if you will reach the Part D coverage gap before the end of the year, and to look for alternatives to avoid reaching the coverage gap.

More information about this tool can be found in this flyer and video.  
 

If you are interested in a lower cost medication alternative to one of your current prescription medications, or want to fill your prescription at a different pharmacy:

• Call your doctor’s office to ask about a new prescription for a lower cost alternative medication.  Your doctor may want to schedule time to discuss it with you first before ordering a new prescription.
• Call the new pharmacy and ask to have your current prescription transferred.  You will need your current pharmacy’s name and phone number, and your prescription number.  If your prescription does not have refills or needs to be renewed, the pharmacy may ask you to contact your doctor first.
• Call Blue Shield Customer Service using the phone number on the back of your member ID card.  Our representatives are ready to assist to talk with your doctor and can refer to one of our pharmacy specialists for extra assistance.

How generic medications impact your costs

For many people, generic medications represent a better financial option than brand-name medications, which can help people stay on schedule with their medications and at the correct dosage.

What you should know about generic medications:

• New brand-name drugs are protected by U.S. patents to prevent other manufacturers from selling generic versions of the same medication. Generally, after the patent has expired, manufacturers can make and sell generic versions of that medication to compete with the original brand-name medication.
• Many generics cost 80% to 85% less than brand-name medications.² Generic medications cost less because manufacturers do not have to spend as much on research and marketing of the generics. If you’re taking a brand-name medication, talk with your doctor to see if there is a generic alternative that would be right for you.
• They are safe and effective. Generic medicines that are approved by the U.S. Food and Drug Administration (FDA) have the same active ingredients and work the same way as brand-name medicines. The FDA’s Generic Drugs Program conducts a thorough review to ensure that generic medicines have the same health benefits and risks as brand-name medicines. 

Other brand medications that can lower your costs

Even before generic medications are available on the market, drug manufacturers also develop similar brand-name medications in the same drug category to treat the same condition(s).  These are called “brand alternatives” that compete in the market with the original brand-name medication.  

• Brand alternatives must meet the same FDA requirements for safety and effectiveness.
• These medications may have an advantage over the original brand-name medication such as fewer side effects, formulations that are easier to take, less frequent dosing, and in some cases, better health outcomes.
• Through competition, brand alternatives in the same category help lower the cost of medications for all.