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Why Are Your Prescription Costs Fluctuating?

The cost of prescription medications is often a big concern when budgeting for health care expenses, and rightly so! Part of the challenge is that prescription costs can change even when your plan does not. On Medicare plans that include Part D Prescription Drug coverage, you are usually responsible for paying a copay for your medications. Often, this will give you a clear idea of how much money you will have to spend when you fill your prescriptions. There are some situations, though when the cost of prescriptions will fluctuate.

What Factors Can Influence Prescription Costs?

  • Deductible – If your plan has a deductible, you may have to pay more out of pocket until you satisfy the deductible amount.
  • Pharmacy – Pharmacies can negotiate costs for prescription medications, so you may have prescriptions that differ in price from one pharmacy to another and from one plan to another.
  • Donut Hole – Also known as the coverage gap, the “donut hole” applies to individuals after the total spending on prescriptions has reached a certain threshold. When you are in the donut hole, the amount you are responsible to pay for prescriptions may rise.
  • Brand-Name vs. Generic – If your doctor prescribes a brand-name medication to you, it will generally be more expensive than a generic form.

Note that not all medications prescribed by your doctor will be on your plan’s formulary, so if your doctor prescribes a medication that isn’t on the formulary, ask about comparable options.

We understand that keeping track of fluctuating prescription costs can be tricky! If you have questions about the cost of your prescriptions, we recommend that you contact your health insurance company. Although our team at RetireMed is happy to help you, the representatives at your insurance company have immediate access to your claims history and will be able to provide helpful insight into your prescription costs.

If you are not a RetireMed client and have questions about retirement or Medicare, please contact our team of local advisors at 937.915.3563 to get started on your Medicare journey!



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