This article was updated on August 16, 2018.
The Medicare prescription drug benefit (Medicare Part D) began in 2006 with the goal of helping people pay for their expensive prescription drugs. But even with this benefit, it can be hard to pay for prescription drugs, especially since there is no cap on out-of-pocket spending under Medicare Part D. Here are the 10 most expensive drugs under Part D, the most popular prescription drugs, why prescription drug costs change, and how to save money on your prescriptions.
Most Expensive Drugs Under Part D
- Harvoni (hepatitis C)
- Lantus/Lantus Solostar (diabetes)
- Crestor (high cholesterol)
- Advair Diskus (asthma)
- Spiriva (asthma/COPD)
- Januvia (diabetes)
- Revlimid (multiple myeloma)
- Nexium (acid reflux)
- Lyrica (fibromyalgia/pain)
- Humira/Humira Pen (rheumatoid arthritis)
While the drugs above boast the highest price tags, they are not the most prescribed. As of July 2018, the following are the most prescribed drugs and the conditions they treat.
Most Prescribed Prescription Drugs
- Lipitor (high cholesterol)
- Synthroid (thyroid)
- Prinivil (hypertension)
- Vicodin (pain management)
- Norvasc (hypertension)
- Motrin (pain management)
- Prilosec (acid reflux)
- Cozaar (hypertension)
- Zoloft (mental health)
- Neurontin (seizures and nerve pain)
Why Your Prescription Drug Prices Change
If your prescription drug prices have recently changed, here are three reasons why it may have happened:
- If your dosage or quantity changes, the price of the prescription could also change.
- Manufacturers may increase the price of the drug, and this will be reflected in the price you pay for it.
- You may be in one of four coverage periods: deductible period, initial coverage period, coverage gap, and catastrophic coverage period.
Four Coverage Periods
- Deductible period. If your plan has a deductible, you will have to pay the full cost of your drugs until you meet the deductible. Deductibles can vary from plan to plan, but no plan’s deductible can be higher than $405 in 2018, and some plans have no deductibles at all.
- Initial coverage period. This begins after you’ve met your deductible. During this period, you will be responsible for copayments and coinsurance, which may vary according to your plan. Once you have reached $3,750 in total drug costs, you move on to the next stage.
- Coverage gap. The coverage gap, also called the Medicare donut hole, means your plan does not cover your prescription drug costs. However, discounts are available. In 2018, brand-name drugs will be discounted 65% and generic drugs will be discounted 56%. In 2019, the pharmaceutical industry will be responsible for 70% of the drug cost, and Medicare will pay for 5%. That means 95% of brand-name drug costs will count towards your total out-of-pocket spending, allowing you to reach catastrophic coverage sooner. Medicare plans to close the donut hole altogether by 2020.
- Catastrophic coverage. In 2018, you will reach catastrophic coverage once your total out-of-pocket costs have reached $5,000, regardless of your drug costs. During this time, you will only pay a copay or coinsurance for the remainder of the calendar year. Here are the costs that count toward catastrophic coverage:
- Your deductible
- What you paid during the initial coverage period
- Cost of brand-name drugs (including discounts) paid during the coverage gap
- Amounts paid by others on your behalf
- Amounts paid by State Pharmaceutical Assistance Programs, AIDS Drug Assistant Programs, and the Indian Health Services
How to Save Money on Prescription Drugs
- Go generic. If you’re taking brand-name drugs, ask your doctor if you can take a generic or biosimilar version instead.
- Check the formulary. All prescription drug plans have a formulary, or list of covered drugs. If you want a specific drug covered, you can search your plan’s formulary to make sure it’s covered. Click here to search the Part D (PDP) formulary.
- Do your research. Some drug plans will offer coverage in the Medicare donut hole. These plans will often have higher premiums, but it might be worth it to assure you have coverage all year.
- Check for pharmaceutical assistance. Some pharmaceutical companies offer assistance programs. Search Medicare’s website here to find out if one is available for a drug you take, or search here to find out if your state has a pharmaceutical assistance program.
- Get Extra Help. If you’re living with low or limited income, you may be eligible for Extra Help (or Low-Income Subsidy), which is a Medicare program to help beneficiaries pay for prescription drugs. Apply for Extra Help by contacting your local Social Security Administration office or by clicking here.