We are nearing the time of year when you can change your Medicare coverage choices for the following year. In perusing plan options, questions often arise about Medicare prescription drug coverage. Your local pharmacist can be a useful resource when it comes to answering questions on Medicare prescription drug coverage.
Mike Suwalski, director of Medicare operations for Walgreens, is here to answer questions on prescription drugs and Medicare. Walgreens operates approximately 9,800 stores throughout the United States, Puerto Rico and the U.S. Virgin Islands.
Q: What Medicare-related questions do pharmacists get from people most often? What are the areas of greatest confusion or concern?
Suwalski: One of the most frequently asked questions we hear is, “What is the difference between PDP and MAPD?” A standalone Medicare Part D prescription drug plan, or PDP, covers only prescription drugs. A Medicare Advantage plan that includes prescription drug coverage, or MAPD, is a comprehensive plan that offers complete Medicare benefits, including inpatient and outpatient care, plus prescription drugs. Many MAPD plans also cover dental, vision and hearing care. PDP and MAPD plans are offered by private insurance companies approved by Medicare.
Another common question is asking how Medicare plan benefit changes will affect out-of-pocket costs. For example, prescriptions covered under a certain plan one year might not be covered the same way the following year. Plans may change the copay amount or stop covering a medication entirely. It’s a good idea to review your plan annually to make sure your prescriptions are covered and your pharmacy is in your plan’s pharmacy network.
Q: What vaccines should older adults make sure they are staying on top of?
Suwalski: Staying on top of your vaccines is always important, but becomes more critical as you age. Older adults are more prone to certain preventable diseases like shingles. However, staying on top of your immunizations is easy, as many vaccines are available at your local pharmacy. Some important vaccines to make sure you’re current on include:
- Flu: Make sure you are getting a new flu shot every year. There is a flu shot geared for older adults; ask your pharmacist or doctor for more information.
- Shingles: The new shingles vaccine requires two separate doses, but comes with a higher effectiveness rate compared to past vaccines.
- Tdap (tetanus, diphtheria and pertussis): If you’re around a grandchild or other small children, it is critical to be protected not only for yourself, but also for your grandchild.
Many vaccines are covered under Original Medicare or Medicare Advantage plans. Be sure to contact your provider to learn more.
Q: As people get older, they may take more medications. How can pharmacists help people manage their medications?
Suwalski: Pharmacists can help to identify possible drug interactions, especially if you use the same pharmacy for all your medication needs. They can also help answer questions and warn you about potential side effects and expected outcomes. Pharmacists can provide guidance on the best time to take your medication, offer tips to help you remember when to take it, and be an accessible resource in case you forget the instructions. When cost is a concern, pharmacists can sometimes recommend a less expensive option, such as a generic substitute or an alternate brand name drug.
If you use Walgreens as your pharmacy, be sure to check out our Save A Trip program, which coordinates multiple prescriptions to be ready at the same time. We will work with your insurance provider to approve the scheduled alignment as well as contact your doctor's office if needed. It is a nice way to avoid making multiple trips to the pharmacy.
Q: What tips do you have to help people save money on their prescription drugs?
Suwalski: Saving money on your prescriptions is a great way to bring down your overall health care costs. Fortunately, there are ways to do that.
- Ask your pharmacist or doctor about generic or other low-cost substitutes for any expensive medications you’re taking. Drugs on the lower tiers of your plan’s list of covered drugs (formulary) cost less and could work as well as their high-cost counterparts.
- Think about getting 90-day refills when offered. They typically cost less per dose than 30-day supplies.
- Check to see if your plan has a preferred pharmacy network. Your copay is usually less when you fill prescriptions at preferred pharmacies.
Q: Is there anything else Medicare enrollees should know about using their pharmacy as a resource?
Suwalski: Pharmacists are highly educated medication and immunization experts, and they stay current on the latest advances in medical science. They can help you stay healthy by providing medications, immunizations and information to help you better understand your drug therapy. Pharmacists are local, easy to reach and ready to answer questions and offer tips on what to expect from medications and how to maximize their results.
Before choosing your Medicare plan, ask your pharmacist to provide an updated list of the medications you are taking. This information can be useful when selecting a new health insurance plan. Be sure to take advantage of the annual wellness visit as part of your Medicare plan so your doctor can advise on any changes to your medications or diagnoses.
Editor’s Note: For more information, explore www.NMEW.comOpens in a new tab or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.
As part of National Medicare Education WeekOpens in a new tab, we asked leaders, like Mike, from organizations in the health and aging fields to share their expertise.
Also, be sure to check out the free National Medicare Education Week webinarsOpens in a new tab to learn even more from experts across fields.