Whether to treat a short-term illness or manage a chronic condition, many older adults take prescription medications. But there's no denying that prescription drug coverage and even the medications themselves can be complex territory.
Enter UnitedHealthcare Medicare & Retirement's Chief Pharmacy Officer Mike Anderson, PharmD. Like other licensed pharmacists, he has spent his career navigating the ins and outs of the Rx world.
Below, Mike answers some of the most common questions people ask - about both their drug coverage and their prescriptions.
Q. What's the difference between PDP and MA-PD plans?
A. Original Medicare doesn't provide coverage for most prescription drugs, so if you want help paying for medications, you have two options. You can purchase a stand-alone Part D prescription drug plan (PDP) in addition to Original Medicare or Original Medicare and a Medicare supplement plan. Or you can choose a Medicare Advantage plan with prescription drug coverage built in (MAPD). Medicare Advantage plans can also include additional benefits like dental, vision and hearing coverage, and combine all of your coverage into a single plan. Both plan types are offered by private insurance companies contracted by Medicare.
Q. How do I know if my prescriptions are covered by my Medicare plan?
A. Whether you get prescription drug coverage through Medicare Advantage or a standalone Part D plan, each plan has what's known as a formulary, which is a list of the prescription drugs covered under the plan. These formularies can vary from plan to plan, so you'll want to look closely to make sure your medications are covered. Health insurers post plan formularies on their websites, or you can call your plan to request a printed version of the formulary. Also, keep in mind that plans can change from year to year, so don't assume that the prescription drugs covered this year will always carry over next year.
Q. How can I save money while still remaining on my medications?
A. Saving money on your prescriptions is a great way to bring down your overall health care costs. And fortunately there are many ways to do that.
- Home-delivery pharmacy benefits can be a great way to save not only money but also a trip to the pharmacy. Some mail-order pharmacies offer the convenience of ordering a three-month supply of drugs delivered to your home for a lower cost than purchasing the same quantity of drugs at a retail location.
- If you prefer to visit a retail pharmacy, check to see if your plan offers any programs or preferred pharmacy networks to help you save additional money on prescriptions.
- Prescription drugs are typically sorted into several tiers on the plan's formulary, with drugs on lower tiers generally costing less than drugs on higher tiers. Switching to generic drugs or drugs on a lower tier of the formulary, or list of covered drugs, is another step that could save money. If you are taking brand-name medications now, talk to your doctor to see if a generic alternative may be a good option for you.
Q. What does a donut hole have to do with prescription drug coverage?
A. The donut hole refers to a gap in prescription drug coverage where higher payments are required. Individuals pay a certain amount or percentage of cost for their prescription medication until the amount they have paid adds up to or exceeds $3,750 (for 2018). Then, individuals pay a higher percentage of their prescription costs until they have spent another $1,250, bringing their total spent to $5,000. After that you exit the donut hole and pay a smaller copay.
Q. Can I split my pills in half?
A. First, it's important to talk to your doctor about whether pill-splitting for your medication is medically-advised. Also, consult your pharmacist on whether the actual pill form presents risks. Some pills are dangerous when split, because splitting affects how quickly the drug is released into your body. Other pills become ineffective when split, because the pill contains a coating to protect it from stomach acid, and splitting the pill breaks that coating.
Q. I take a lot of pills daily. One I take three times a day. Another I take twice and then some I just take once. I get busy and forget to take my pills. Can I just take them all in the morning?
A. It's important to take your medicine as your doctor prescribed it. Some medications need to be taken at specific times in order to be effective in treating the conditions for which they have been prescribed. Plus, taking all your medications at one time can be dangerous as you run the risk of potential adverse interactions, side effects and even overdosing.
Q. My kids have gotten me started on smoothies with powdered supplements, and I also take vitamins. Can these have a bad interaction with my prescriptions?
A. That's a great question to ask. Many people don't think about how these might interact with their medications. If an iron supplement was added to the smoothie, for example, that could reduce the effectiveness of thyroid medication and medication for reflux disease. Talk to your pharmacist and doctor about the vitamins and supplements you are taking to learn if they could cause a reaction or make your medications less effective.
Q. What is the difference between aspirin, acetaminophen, ibuprofen and naproxen? Don't they all do the same thing - relieve pain?
A. Yes, these medications all relieve pain. The important differences include the chemical composition of each type and how they interact with other drugs or with certain medical conditions. Aspirin, ibuprofen and naproxen are classified as nonsteroidal anti-inflammatory drugs (NSAIDs) which reduce pain, fevers and inflammation. That's the good news. The bad news is that the relief comes with the possibility of stomach bleeding and heart problems as side-effects. In addition, NSAIDs can raise blood pressure. Acetaminophen is not an NSAID. It reduces fever and pain but does not reduce inflammation. Prolonged use of acetaminophen can lead to liver disease. To find the best option for you, talk with your doctor or pharmacist.
Q. I just got my medication refilled. It used to be a different color and shape. I checked the label, and it says it's the right medicine. How does it look different?
A. Good for you for noticing your medicine looks different. More than likely, the pharmacy you use bought their supply from a different manufacturer. Drug companies who make the same medication must keep the chemical formula the same. However, they may change the shape or the color of the medication. As long as you verify it's the same medication and the same dose, it should work just like before. If you still have concerns, talk with your pharmacist
For more information to help you navigate prescription drug coverage, visit MedicareMadeClear.com.