Prescription drug costs continue to be a concern for many people — in fact, the vast majority of Americans believe the cost of prescription drugs is unreasonable. Medicare annual enrollment is upon us, and understanding what prescription coverage you might need is important — especially given Original Medicare generally doesn’t cover medications.
Instead, you can get prescription drug coverage in two ways:
- Through a separate stand-alone Part D plan, which works with Original Medicare and Medicare Supplement Insurance plans.
Or
- A Medicare Advantage plan with prescription drug coverage, for an “all-in-one” package and can be a great way to help keep your prescription costs in check.
In addition, here are three simple tips to help you get the most out of your coverage.
1. Consider home delivery. Check to see if your plan has mail-order pharmacy benefits – if it does, this can be a great way to save money and a trip to the pharmacy. Through ordering a three-month refill on medications, you may get a discount on your prescriptions and the added convenience of having your drugs come to you.
- What else? Access to medication in the home can be a smart choice. In 2022 and 2023, most standard UnitedHealthcare® Medicare Advantage plans offer $0 copays for tier 1 and tier 2 drugs ordered through the Optum RX home delivery pharmacy, or through participating preferred retail pharmacies.
2. Consider generics or preferred formulary alternatives. Prescription drugs are typically sorted into several tiers on the health plan’s list of covered drugs, known as a formulary, with generic or lower-tier drugs typically costing less than drugs on higher tiers. Often, there are clinical alternatives available on lower tiers, and your doctor can help determine what might be an appropriate option for you. You also have the power to ask whether more affordable alternatives are available, such as a generic or a drug on a lower tier of your plan’s formulary.
- What else? Good news for UnitedHealthcare Medicare Advantage members: More than 26 drugs are moving to a lower tier, giving members greater access to a wider variety of drugs for a $0 copay.
3. Check to see if your plan offers other savings opportunities. It’s never a bad idea to simply call your health plan, or your agent, to see if there are other ways to save that might not be on your radar. For example, if you like visiting the pharmacy rather than using a mail-order service, you should check to see if your plan has a preferred pharmacy network, which means you can get your drugs at a lower copay when you visit a preferred pharmacy. And this year, UnitedHealthcare’s Medicare Advantage formulary will have more drugs in Tier 1 than ever before.
- What else? Changes to Medicare costs are coming in 2023, including a $0 cost share for covered vaccines, and a $35 cap on covered insulins (Part D starting January 1, 2023, Part B starting July 1, 2023). To learn more, visit this article.
The prescription drug landscape can seem complex. But there is help available. Call the number on the back of your insurance ID card and ask about your plan’s coverage. If you are a UnitedHealthcare member, there is a new tool within the member portal – an Rx Online Marketplace – that enables members to compare drug prices, manage refills and have orders delivered to their home or picked up at a convenient pharmacy.
For more information on UnitedHealthcare Medicare plans, visit UHCMedicareHealthPlans.com.
$0 copay may be restricted to particular tiers, preferred medications, or home delivery prescriptions during the initial coverage phase and may not apply during the coverage gap or catastrophic stage. Optum Rx is an affiliate of UnitedHealthcare Insurance Company. You are not required to use Optum Rx home delivery for a 90-100 day supply of your maintenance medication. Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply.
You will pay a maximum of $35 for each 1-month supply of Part D covered insulin drug through all coverage stages.
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies. For Medicare Advantage and Prescription Drug Plans: A Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan’s contract renewal with Medicare.
