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FAQs on Retail Drug Pricing



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Category: Retail Drug Pricing


Most Viewed FAQs in Category
What is the Medicare Part D "Lesser Of" logic?
In the Medicare Part  D prescription drug program, the "lesser of" logic ensures that Medicare beneficiaries are not paying more than their Medicare plan's negotiated retail price for their drugs . . .

Am I allowed to use a Drug Discount Program instead of my Medicare Part D plan?
Yes.  Medicare Part D prescription drug coverage is voluntary and, if you find a cheaper place to purchase medications, then you are permitted buy your medications without using your Medicare Pa . . .

What will my drugs cost in the donut hole? Negotiated price of insurer or retail price? How can I find out my cost of drugs in the donut hole?
You would pay your Medicare Part D plan's negotiated retail price, less the Donut Hole Discount.You can see an estimate of the cost of your medication during all phase of coverage on a particular Medi . . .

Who determines the retail price of Medicare Part D drugs?
Many Medicare Part D prescription drug plans use a PBM or Pharmacy Benefit Manager to negotiate the plan's retail drug prices.  PBMs might also establish pharmacy networks, offer mail-order phar . . .

Can I use a Drug Discount card with my Medicare Advantage plan or are these programs excluded from people with Medicare?
Yes - you may be able to use the card.  But no - the card will not work with your Medicare Advantage plan.  And yes, the card may have "fine print" that excludes Medicare beneficiaries from . . .

Can I use my Medicare Part D plan with a network pharmacy that always offers lower retail prices.
Yes.  If a network pharmacy's retail price for a formulary prescription is lower than your Medicare Part D plan's negotiated retail price, and you are using co-insurance (for example you pay 25% . . .

I currently use two prescriptions and my Medicare Part D prescription drug insurance does not pay anything for either one of these drugs. Does the retail cost of these two medications add into the calculation towards my Doughnut Hole?
No.  If a prescription medication is not covered by your Medicare Part D plan, then the purchase price for this non-formulary drug is not counted toward your Initial Coverage Limit - and is not u . . .

If I am traveling and need to buy Part D drugs, will my drug cost change based on the state I am visiting?
It depends.  In general, you should find similar drug costs as you travel across the country.  But, since retail drug prices can vary between network pharmacies, your actual drug costs can . . .

Will I be able to use my drug store drug discount card with a Medicare drug plan?
Yes, but probably not with your Medicare Part D plan coverage.  Drug stores issuing the discount card will determine what type of discount will be applied to the drug.  Generally, drug store . . .

How do retail drug price increases affect my Medicare Part D drug plan coverage?
Higher retail drug costs mean you may pay more for your coverage, will have less coverage before entering the Donut Hole, and pay more in the Donut Hole. Based on retail drug price increases, your . . .

Newest FAQs in Category
Does my Medicare Part D plan charge the "average negotiated retail price" that your Drug Finder shows?
Maybe.  It all depends on how your Medicare prescription drug plan (PDP or MAPD) has negotiated the retail drug pricing with the pharmacies in your area.  In many cases we find that the aver . . .

Can I use a Drug Discount card with my Medicare Advantage plan or are these programs excluded from people with Medicare?
Yes - you may be able to use the card.  But no - the card will not work with your Medicare Advantage plan.  And yes, the card may have "fine print" that excludes Medicare beneficiaries from . . .

If I am traveling and need to buy Part D drugs, will my drug cost change based on the state I am visiting?
It depends.  In general, you should find similar drug costs as you travel across the country.  But, since retail drug prices can vary between network pharmacies, your actual drug costs can . . .

How do retail drug price increases affect my Medicare Part D drug plan coverage?
Higher retail drug costs mean you may pay more for your coverage, will have less coverage before entering the Donut Hole, and pay more in the Donut Hole. Based on retail drug price increases, your . . .

Who determines the retail price of Medicare Part D drugs?
Many Medicare Part D prescription drug plans use a PBM or Pharmacy Benefit Manager to negotiate the plan's retail drug prices.  PBMs might also establish pharmacy networks, offer mail-order phar . . .

Am I allowed to use a Drug Discount Program instead of my Medicare Part D plan?
Yes.  Medicare Part D prescription drug coverage is voluntary and, if you find a cheaper place to purchase medications, then you are permitted buy your medications without using your Medicare Pa . . .

What will my drugs cost in the donut hole? Negotiated price of insurer or retail price? How can I find out my cost of drugs in the donut hole?
You would pay your Medicare Part D plan's negotiated retail price, less the Donut Hole Discount.You can see an estimate of the cost of your medication during all phase of coverage on a particular Medi . . .

Is a medications negotiated retail drug price the same for every Medicare Part D drug plan?
No. You will find that the negotiated retail drug price for each medication may differ: between every Medicare Part D plan (or Medicare Advantage plan that includes prescription drug cover . . .

I currently use two prescriptions and my Medicare Part D prescription drug insurance does not pay anything for either one of these drugs. Does the retail cost of these two medications add into the calculation towards my Doughnut Hole?
No.  If a prescription medication is not covered by your Medicare Part D plan, then the purchase price for this non-formulary drug is not counted toward your Initial Coverage Limit - and is not u . . .

What is the Medicare Part D "Lesser Of" logic?
In the Medicare Part  D prescription drug program, the "lesser of" logic ensures that Medicare beneficiaries are not paying more than their Medicare plan's negotiated retail price for their drugs . . .






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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
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  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.