Use a Different Pharmacy for $4 Generic Drugs by Mary Jane Stern

One of the best things that happened here in the USA was Wal-Mart initiating their $4 generic drug program and most major pharmacies followed Wal-Mart.  That can really save you some money on your prescription drugs whether you're a Medicare beneficiary or not.

However, as we learned, the hard way, you have to be careful purchasing your generics especially when you participate in Medicare D.  Let's face it, whether it's the pharmacy or the doctor's office, the first question you're generally asked, "What is your insurance?" or "Do you have a prescription drug plan?"

The problem is that the pharmacy never stops to ask if you want to pay cash for the $4 drugs, they just run your prescription card. If you are enrolled in Medicare D whether a standalone plan or one associated with a Medicare Advantage plan, pay attention to your purchases of $4 generic drugs, because you are generally charged a retail price against your allowable limit on Part D and that can be anywhere from $15-$20 for a one month supply and more on some drugs.

Use Different Pharmacies
The best thing you can do is shop at two different pharmacies.  Buy your high cost prescription drugs with your Medicare D plan.  Use another pharmacy to buy your $4 generic drugs and do not give them any information about your Part D plan.  Purchase as if you have no insurance!

Do not include $4 generic drugs in your Medicare D plan!

The Savings is Worth the Inconvenience
It does seem like an inconvenience to use two different pharmacies, but it would be more of an inconvenience if you had to start paying the retail price because your $4 generic drugs pushed you into the "coverage gap."

2009 Allowable Limit
The allowable limit during 2009 for Part D is $2,700 in total retail charges before you reach the coverage gap. 

If you or someone close to you has a chronic condition that requires monthly prescription drugs, you know how quickly those charges can add up.  Brand name drugs have an average retail price ranging from $100 - $125 for a 30 day supply.  Now add the $20 generic drug charge per month against your allowable limit and you reach the coverage gap a lot quicker than you anticipated.

Then what - retail price until your total retail prescription costs reach $6,153.75 - this means you could pay up to $3,453 out of your own pocket.

Think of it this way, you're going to pay the $4 no matter what - whether it's a co-pay or a cash purchase.  But a cash purchase doesn't go against your Part D allowable limit, and helps keep you out of the coverage gap.

We actually got charged $12 against our Part D allowable limit for a $4 medication.  That's when we decided to use two pharmacies.  One for brand - one for generic.