Can I use a Drug Discount card if I am enrolled in a Medicare Advantage plan?
Using Part D with other drug programs · updated Jul 20, 2024
However, you will need to read the discount card's "fine print" as some drug discount programs are not available to Medicare beneficiaries.
In fact, you are not required to use a Medicare drug plan and instead, you can purchase medications without using any drug coverage if you find that your pharmacy provides low discounted prices or lower everyday prices. You may also be able to use discount coupons at some pharmacies (such as are provided by GoodRx.com, but again, you will need to read the "small print" on the coupons to ensure that you are eligible for any discount). You can click here to read our tips on using a drug discount program: ( on this site).
Question: Does a Drug Discount Card work together with a Medicare Advantage plan (MAs) or Medicare Advantage plan that include drug coverage (MAPD)?
Not exactly. If you enroll into a Medicare Advantage plan that includes drug coverage (MAPD), you would be using the Discount Card instead of (but, not together with) your Medicare Advantage plan's drug coverage. In other words, you cannot use a Drug Discount card or a pharmacy's drug discount program along with your Medicare drug plan coverage. If your Medicare Advantage plan does not include prescription drug coverage (MA), then you would be using the Drug Discount card outside of your Medicare plan coverage. Question: What happens when your Medicare plan's drug copay is more than your pharmacy's everyday retail cost?
You pay the lower retail cost, not the copay. If you are using one of your Part D plan’s network pharmacies and the pharmacy’s every-day retail price is lower than your plan’s cost-sharing (or copayment), you will only pay the lower retail cost and not your plan's cost-sharing. So using your Medicare Part D drug plan will have no effect on your prescription cost when the pharmacy's everyday price of a drug is lower than your copay. For example, if you purchase a medication and your drug plan has a $30 copay, but the pharmacy has an everyday price of $25 for the same drug, then you will pay the lower retail price ($25) and not your plan's $30 copay (for more information please see our Frequently Asked Question on this site).
Pharmacy Discount Programs as compared to Pharmaceutical Assistance Programs (PAPs)
As mentioned above, there are several different types of drug discounts available and some discounts are not available to people who are eligible for Medicare. In particular, some pharmaceutical companies offer Pharmaceutical Assistance Programs (PAPs) where drug companies offer expensive medications at a reduced cost to people in economic need (but perhaps not eligible for Medicaid).
Often, a PAP will have some "eligibility requirements" stating that the discount is not available for people who are eligible for Medicare or people who already have drug coverage.
For instance, you might read in the "small print": "Patient must [n]ot have private or public prescription coverage [in order to be eligible for the program]."
If you cannot find any eligibility information on a discount offered by a pharmaceutical manufacturer's PAP, then you can call the company for more information - a customer service telephone number is usually given along with the PAP information.
Medicare also offers a site with more information about Patient Assistance Programs (along with PAP contact information): www.medicare.gov/ pharmaceutical-assistance-program/