Using prescription manufacturers’ coupons and Medicare together, to pay for medications is illegal. But, you can use drug coupons instead of using Part D. It’s smart to use the coupon when Part D would cost more than using a coupon or discount card.
Why Can’t Medicare Patients Use Prescription Coupons?
Using drug coupons for medications is perfectly legal. But, combining them with Part D coverage isn’t allowable. When using drug coupons, you must pay without using your Part D plan.
Determining when you’ll save more money is the tricky part. Pharmacies can leave your options unclear, making it hard to decide which option is more cost-friendly.
Partially due to the contracts that pharmacies and pharmaceutical companies have with each other.
Pharmacy benefit managers act as “middlemen” negotiating contracts between the two parties. Pharmacy benefit managers establish drug formularies, set up discounts and rebates for manufacturers, and process the pharmacy’s claims for prescription medications.
Best Prescription Discount Cards
The eight most popular discount programs are:
- GoodRx
- Script Relief
- SingleCare
- ScriptSave WellRx
- Blink Health
- The U.S. Pharmacy Card
- Medicare Plus Card
What is The Anti-Kickback Statute?
Social Security Amendments of 1972 made it illegal for pharmaceutical companies to give discounts for any medications bought through Medicare. The 1972 Amendments also include the Anti-Kickback Statute. Making it illegal for anyone, to offer drug coupons and rebates to customers for items or services that a federal healthcare program pays.
When a pharmaceutical company suggests you choose a more expensive drug option, Medicare spends more money than if you chose the lower-cost generic medication. Although the manufacturer offers a discount, coupons are generally for their newest and more expensive medicines.
Also, these drug coupons usually have a small lifespan plus an annual maximum cost. This means you and Medicare would be responsible to pay the remaining amount for the rest of the year.
The Anti-Kickback Status prevents individuals from abusing the system. In turn, Medicare reduces cost spending.
Can Medicare Patients Use a Discount Card with Part D?
Now, you can use a discount card instead of Part D! For more information on if you qualify for a coupon, you can always contact your pharmacy or the manufacturer.
Can Medicare Patients Use GoodRx Prescription Coupons?
GoodRx is a free program that gathers discounts and the most current drug costs. If you have Part D, can you use GoodRx? Yes, you can use GoodRx when you have a Part D plan.
In some cases, the prices may be lower than what you’ll pay through insurance. So just how does GoodRx provide you with these exceptional prices? GoodRx gets its pricing from several different avenues. The most popular channel is the price negotiations.
GoodRx negotiates with pharmacy benefit managers. Which provides customers with discounted drug costs. Pharmacy benefit managers are third-party administrators of drug programs for drug plans.
Can I Use a Drug Discount Card with Medicare Advantage?
Medicare Advantage plans prove to be helpful. But even if you don’t have drug coverage through your Advantage plan, you can still save money on your medications.
Many Medicare Advantage policies include Part D. Just like with Medicare, you can use either your built-in coverage or a discount drug card. You can use your discount card to save on your drug costs if it saves you more money than your Medicare Advantage plan.
FAQs
How to Use Prescription Coupons When You Have Medicare
We understand, especially on a fixed income, that you’re looking for ways to save money. Drug discount coupons and cards can seem like an appealing option. Yet, it’s essential to be informed about the facts.
That’s where we can help. We’ve assisted countless individuals in signing up for the right Part D prescription drug plans, and we can do the same for you. Just call the number above or fill out an online rate form. You’ll be able to compare plans in your area, and we’ll help you make the best choice.
I have noticed a lot of the manufacturer’s coupons now read that you cannot use the coupon if you are “eligible” for any government sponsored coverage. Example: “ This offer is invalid for patients without commercial drug insurance or whose prescription claims for Trulicity are eligible to be reimbursed, in whole or in part, by any governmental program, including, without limitation, Medicaid, Medicare, Medicare Part D, Medigap, DoD, VA, TRICARE®/CHAMPUS, or any state patient or pharmaceutical assistance program.” The pharmacy will not allow you to use the coupon instead of your Medicare plan based on that wording.
Very good information on high dollar drugs and the use of coupons. You would think Medicare would want to pay the lowest price possible and pass it on to the beneficiary. My sister could pay $174 a month for a drug she needs by using a coupon whereas through Medicare she would have to pay $561 per month. Doesn’t make any sense.
Peggy, we understand your frustration. Unfortunately, each drug plan uses a different formulary which covers drugs differently depending on the pharmacy you use. If you can find a coupon to lower your drug cost, you can always use the coupon rather than your Part D coverage.
so then… if I am understanding… one can be on Medicare and SSA or SSDI and use a Manufacturers Savings Card for a prescription drug long as long as you don’t have Part D coverage correct?
KC, Part D drug coverage can definitely be confusing! If you are using Part D to cover a prescription, you would not be able to use the manufacturer savings card in addition to your Part D coverage. However, if you wanted to use the savings card in place of your Part D coverage, that would be acceptable. You can always use one or the other, but you cannot stack coverage.
If I use goodrx for a discount does the money I pay go toward my part D deductable?
Hi George – no, the money does not go toward your Part D deductible because you can’t use Part D and GoodRx in conjunction with each other. While you can keep Part D and use GoodRx discounts for your prescriptions, you can’t use both at the same time.
Since I take few prescription drugs, I never reach my deductible, consequently I pay full cost for my drugs as well as a monthly charge to my prescription drug plan (which just went up). Should I just use my Good Rx coupon?
Hi Norma – if you get a better deal from the GoodRx coupon, you can choose to use it in that circumstance. Yet, we wouldn’t recommend unenrolling from a Part D plan entirely; gaps in creditable drug coverage will expose you to a penalty in the future.
I tried to havr my pharmacy use manufacturer coupon instead of my medicare part D prescrip plan and they said I could NOT?????
Hi Maureen – you should be able to use the coupon instead of your Part D plan. You just can’t use it in conjunction. Ask to speak to the pharmacist if you only spoke to a tech.
So, can I tell my pharmacy to use my copay card (free drugs) instead of my supplemental insurance I purchased last month?
Hi DJ, yes – if the drugs are lower in cost with a discount card, you can use it instead of your Part D insurance. Additionally, other than Part D and Advantage plans, no other supplemental Medicare insurance covers prescription drugs, as Medigap plans cover the same as what Medicare does.
Can you use the coupon if you have medicare part B?
Hi Monique, you can use prescription discount coupons if you have Part B, an Advantage plan with prescription drug coverage, or even Part D! The only caveat is that you can’t use them in conjunction with each other.
Thanks for a great article. Can you specify exactly which CMS provisions allow a Medicare recipient to choose whether to utilize a manufacturer’s coupon or their Medicare coverage?
Hi Sharon! You can tell the pharmacy to use your coupon instead of your Part D plan at any time.