Medicare Patients Can Pay Cash



A simple question at the pharmacy could unlock savings for millions of Medicare beneficiaries.

Under a little-known Medicare rule, they can pay a lower cash price for prescriptions instead of using their insurance and doling out the amount the policy requires. But only if they ask.

That is because pharmacists say their contracts with drug plans often contain "gag orders" forbidding them from volunteering this information.

Medicare patients can pay cash

As part of President Trump's blueprint to bring down prescription drug costs, Medicare officials warned in a May 17, 2020 letter that gag orders are "unacceptable and contrary" to the government's effort to promote price transparency.

Medicare patients can get the lower price, when it's available, simply by asking. If they are paying cash, the patient should discount cards from sites such as GoodRx.Com and AffordableMeds.Org. These sites offer “coupons” that offer cash paying patients huge discounts.

Researchers analyzing 9.5 million Part D prescription claims reported in a research letter to Journal of the American Medical Association in March that a patient's copayment was higher than the cash price for nearly one in four drugs purchased in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33 percent.

Although the study found that the average overpayment for a single prescription was relatively small, researcher Newman says he has seen consumers pay as much as $30 more than the cash price.

And many beneficiaries may not know that if they pay a lower cash price for a covered drug at a pharmacy that participates in their insurance plan and then submit the proper documentation, insurers must count it toward their out-of-pocket expenses. The total of those expenses can trigger the drug coverage gap, commonly called the doughnut hole. (This year, the gap begins after the plan and beneficiary spend $3,750 and ends once the beneficiary has spent a total of $5,000.)

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