Medicare patients may lower drug costs by not using their insurance

(Reuters Health) - Generic medicines for many common health problems like high blood pressure and diabetes may cost Medicare patients less when they pay cash instead of using their health insurance, a U.S. study suggests.

Researchers compared out-of-pocket costs for 30-day supplies of 27 different medications for conditions related to cardiovascular disease. They looked at how often these prescriptions cost more than $4 - the amount charged by Wal-Mart’s drug discount program - when people used one of 622 different standalone Medicare drug plans or one of 1,533 different health insurance plans known as Medicare Advantage.

Half of the time - across all the different medications and types of coverage - at least 21 percent of the Medicare plans required patients to spend more than $4 for covered generic prescriptions.

“We already know from consumer reports that beneficiaries can sometimes get better deals by paying the cash price (without using insurance) at a pharmacy or at a generic drug discount program, rather than paying the copay using their insurance, but there wasn’t good data on how this varied across plans,” said senior study author Dr. Joseph Ross, a professor of medicine and public health at Yale University in New Haven, Connecticut.

“Our results demonstrate that a surprising percentage of plans - particularly Medicare Advantage plans - have cost-sharing structures in place that may not give the cheapest option to their beneficiaries for common generic cardiovascular drugs,” Ross said by email. “We know that higher costs lead to lower patient adherence to their medication treatments, which can worsen management of these common cardiovascular conditions if patients are delaying refills because of costs.”

For all of the drugs in the study and all of the various plans, half of the time the out-of-pocket cost was just $2, researchers report in the Annals of Internal Medicine.

Out-of-pocket costs might be lower with Medicare’s stand-alone drug plans than with Medicare Advantage plans, the study also found.

With generic drugs in what’s known as tier one - the lowest-cost prescription drugs - half of the medications cost at least $2 with Medicare Advantage. But with the Medicare drug plans, half of the drugs cost no more than $1.

On higher tiers of benefits that mean higher out-of-pocket costs, medicines cost at least $10 half of the time with Medicare Advantage, compared with $3 for stand-alone drug plans.

“For patients, the main take home message is that they should be sure to shop around and check whether their medications are available at a local generic drug discount program for a price below what they are paying when they use their insurance at the pharmacy,” Ross advised.

One limitation of the study is that it’s not clear if the results of the cost analysis for drugs for cardiovascular conditions would be applicable to medicines for other health issues.

To keep costs down, seniors should shop for a new Medicare plan every year during open enrollment to find one that offers the lowest prices for medicines they need and for pharmacies close to home, advised Stacie Dusetzina, a health policy researcher at Vanderbilt University School of Medicine in Nashville, Tennessee, who wasn’t involved in the study.

Patients can also check cash prices online using tools like or ask the pharmacist about any discount programs available, Dusetzina advised.

“While some states prohibit pharmacists from offering this information up front, if you ask, they will tell you and you could save some money,” Dusetzina said.

SOURCE: Annals of Internal Medicine, online July 23, 2018.