Not only can Medicare drugs costs add up, but they may take some research to find the right plan that covers your specific prescription and administered drug needs.

Part B Drug Coverage?

Did you know some of your drugs are covered by Medicare Part B? If you didn’t, don’t feel bad, most people don’t realize this. The reason you may not know this is because there are only a handful of drugs covered by Part B, and usually those drugs are ones you would not administer yourself, such as injectables, antigens (can be administered by patient if properly instructed), and some drugs used with durable medical equipment.

Medicare Costs for Part B Drugs

If you have Original Medicare you’ll pay 20% for Part B drugs. This may not sound like a lot, but when you consider that a drug like Soliris costs $440,000 a year, your out of pocket costs would be $88,000 just for the drug. Yes, that’s an extreme example, and it’s meant for the treatment of two types of rare blood diseases, but you get the picture. However, if you have any Medigap policy, 8 out of 10 plans will cover this cost completely.

Part D Coverage

Part D coverage offers prescription drug coverage for drugs that generally are not administered in an out-patient setting, therefore the majority of your drugs. These drugs can also really add up. For instance, a drug like Stelara is a specialty tier 2 drug. If you don’t have Part D coverage or if you have a prescription drug plan that does not cover this drug it would cost you over $190,000 a year. With a Part D plan that covers this drug, your costs can be as high as $11,000 a year. While Part D does not absolve you of the high cost of the drug, it does significantly reduce it.

Note: at times Stelara may be covered by Part B (you need to check with Medicare), if so Medigap would cover all or part of your costs (depending on the plan). Medigap does not fill in the gaps of Part D coverage.

Tips to Lower Drug Costs

Here are a few tips to lower your out of pocket drug costs:

  • Get a free discount card that can save you up to 80% of your prescription costs
  • Medigap can significantly reduce or eliminate Part B drug costs
  • Learn how your Medicare Advantage plan determines which drugs should be administered (can be different than Original Medicare, and could have different costs)
  • Make a list of all of your drugs to determine which MA plan w/drugs or stand-alone drug plan is right for you

For further questions about the costs of Medicare drugs call 800-930-7956.